 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to The Therapy Show behind closed doors with myself Jackie Jones and the wonderful Mr Bob Cook and we're up to episode 144 Bob. Good god. I know. Where does the time go? And what we're going to be talking about in this episode is a really interesting title Sequences of Psychotherapy. Yeah before I start that I was attempting to say every time you say at the beginning of the podcast what number it is like 143 144 I often I usually have the same reaction gosh I can't um that somehow we've got 244 which is the same reaction I've had today so at least are we not to nearly three years we've been doing this Bob? Time goes so power goes so fast. It's ridiculous isn't it when you think about it? Yeah I'm in my 74th year. Wow. I know when it goes like that. Okie dokie then it's about psychotherapy really this video when I sent the title in I called it Sequences of Psychotherapy and that's mainly because as a marvellous book and I can't remember who wrote it and the book was called Sequences of Psychotherapy Process which is probably why I call this type of a podcast sequence of the psychotherapy processes. When I think about it really for the listeners though what we are talking about is different stages a psychotherapy treatment goes through. Yeah now when I went on my first training all those years ago they never called the stages or sequences they called the process a treatment plan so they'd say right let's find a treatment plan for you which is basically what we went through was the stages of the every process and sounds very medical that doesn't it a treatment plan? Yeah yeah I much prefer stages or sequences of a psychotherapy process the treatment plan and of course in some ways I used to think then as I think now yes we can look at the overall picture of you know the stages of the psychotherapy process um metapaspectively but we can also look at what goes on in terms of sequences of one psychotherapy session so you've got the 15 minutes has its own sequences as well if you like as as well as the overall direction of the psychotherapy process so according to whether you're a long term psychotherapist or a short term psychotherapist there still will be overall sequences of a psychotherapy process as well as what happens is in the 15 minutes as well yeah so if we look at this in an overall way I remember back in the day looking at what the treatment planning they called it then or we'll talk about in terms of overall stages of a psychotherapy process and they nearly all started with a phrase which we're used to now um in 2024 back then that's just 1984 I think um and that is back then it was called creating a working alliance as the first I like that phrase of a psychotherapy process most books would start with that um stage that in the psychotherapy process however long it took your focus would be at the beginning in creating a alliance with your client yeah and that was often called creating a working alliance what do you like about the phrase I just like the sound of it that it's it is a working collaboration between the two of you it's not just you doing it to the person they're involved in the process as well oh you like the the aspect of a co-created relationship absolutely yeah to your mind when I said creating a working alliance yeah I was thinking when you said that I was thinking the next question which brings to mind of course is how does the therapist know when a working alliance or a co-created relationship or that first of stage if you like uh which I think is so important which I'll talk about in a minute how do how does the therapist know when that's actually happened it's a really good point yeah it seems to say it's in a way yeah okay to us trainees um you know first age is um creating a working alliance and I remember thinking at the time we're 40 years later now yeah that's fine but how do we know when that's actually happened and that is really important how do we know it's all right seeing it written down and that we need to achieve one and maintain one but yeah so if we use that phrase working alliance as the first stage then what is a working alliance and then we can look at how do we know it's being created well working alliance is basically the fundamental relationship that you first cement the client which includes things like trust yeah there's trust between the two people um a sense of secondly a sense of knowing each other to a certain degree whether it's actually got a transferential bent on it or not thirdly for me and I'm going to use a ta language again when there's been a comprehensive script analysis completed yeah that's why the I think that's why the word working is in the description of this first stage for you know other other um disciplines away from ta might have I think things like an accurate formulation or a comprehensive analysis or a I can't think I was just thinking what you might have in counseling but in ta it's often a comprehensive script analysis where you've looked at the or you've talked with the client about how the first how their plan or how can I put this their unconscious life script yeah related and in ta the negative messages and the positive messages and the early decisions that were formed that makes up the unconscious life plan which in ta and is called script that's why this is called script analysis so in the first stage you're working towards getting an accurate script analysis as well as building fundamental human attributes around trust and genuineness and an accurate sense of attunement I think they all make up this first stage and of course in the again in ta it might not be the same I know it certainly is an ingestual psychotherapy for example but ta certainly uh what you would include in this first stage is a contractual process in other words there's a bilateral contract between the therapist and client developed not only an overall level in terms of what the person wants to achieve and perhaps more importantly how they might sabotage themselves achieving that um this would make up the contract um overall but also maybe what makes up a seasonal contract at the same time what does a person want from the the session for a session third session etc etc so you've got two aspects of contractual theory but in establishing a work in lines um contractual method it's really important so we've got contractual method we've got script analysis we've got a sense of attunement we've got trust being built we've got getting to know each other there um I think they those are the things that build up a first stage in psychotherapy for me yeah is that how you see it as well absolutely yeah yeah add do you think say that again sorry is there anything to add from your frame of reference in this working stage that we're talking about I don't think so no I think I think you've pretty much got everything there I think that attunement and you know the working together at the right pace and all that sort of stuff I think that's really important and it's not something that happens on the first session this is something that's going to build up over time oh yeah that's right and also in the first stage what I often like to do with my clients is talk about how the past affects the present yeah yeah and usually you might call the second edgative therapy I don't know usually not only a discussion about what how the past affects the present but really a little bit about what psychotherapy is so as well as getting a contract explaining to them what psychotherapy is and a little bit about how the past affects the present and what that needs on to a script analysis and in that of course you've got contracting as well and in that how they might sabotage themselves achieving the contract yeah I think that makes up the first stage now the question is how which the next question was how do we know when we've achieved that well for me of course is one when we've actually finalized a contract yeah we've finalized and talked about and explored how a person might sabotage their contract which they will by almost by definition because otherwise they wouldn't be in therapy they would have achieved what they wanted so um you know that's another way of knowing perhaps when we've achieved the working lines when we've got a accurate behavioural observable specific contract in mind and it's been some therapists may not do this and it's been signed by both parties yeah now not all therapists will ask their clients to sign the contract um I don't know do you no no but quite a few to anything the original one I do that you know the practical arrangements for the session not necessarily the contact if that makes sense but that's the other thing I hadn't included in the first stage I was talking about treatment contracts yeah the business contracts will be in that first stage almost before you begin therapy yeah I get them to sign that side of things you know that they won't turn up under the influence and cancellation policy and all that sort of stuff they sign that but not the treatment plan they come with part of that initial contract I say you know what are you hoping to get out of a therapy or why are you coming to therapy and you know what do you want to get out of it so there's a little bit of it but it's not in in-depth yeah so the maintenance contract sorry the admin contract but there's treatment contract as I said um exploring how they might sabotage that yeah in fact it's really important I think and then again an accurate formulation or an accurate script analysis looking at the negative messages um and the drivers that make up the early decisions that the client makes becomes part of this early stage and within all that lot we know when the working alliance has honestly been finished but it's working is when there's an element of trust and genuineness between the two people the client and the therapist yeah I think they all make up the first stage yeah and am I right in thinking that the that the contract is you know adaptable because I know that people have come to see me with one thing in mind and then we've kind of something else has happened in the life and that's taken over so it's not like it's written in storm no no it isn't Jeff but no it isn't and also um you may have an overall contact so somebody comes to you and says well I don't really know why I'm here yeah I feel level anxiety and depression and stress in life that I'd like to change yeah um and then you would explore what you would what you want what the client wants instead of feeling depressed stressed and everything else yeah um and then you make the contract that's an overall contract now in the sessions that follow which could be yeah 6 to 160 um you may meander into many different areas of their life talk about many many many things um and you probably have lots of sessional contracts to do that yeah well that doesn't take away the overall contract that you made at the beginning absolutely yeah not mutually exclusive they sort of work together yeah contract somehow will fit into the overall contract yeah so I think you know when you build up a work in lines in your guts you'll know that how you to get on you'll know um whether trust a sense of trust has been established uh you'll know through an accurate contractual method uh you will establish an accurate script analysis and then you'll probably decide uh where you go from then which takes us into the second stage I forgot one thing I forgot which Eric Byrne talked about who's the originator of transactional analysis we talked about in this first sequence or first stage of the site of their process it's important to do an accurate ego state analysis as well as script analysis now away from ta you wouldn't necessarily be doing that but in transactional analysis Eric Byrne did talk about in this first stage of psychotherapy process which is you know in sort of uh general terms might be called working alliance establishing a work alliance you would do as well as a script analysis an accurate ego state analysis which is now analyzing which or how much energy is present when they actually present and from what ego state so if they're coming generally from an active parent ego state in energetic terms they will be they will have a lot of energy and parent behavior or parent or parent language I must do this or should do this or yeah and they may present it just like their father did or their mother did or or a significant other that brought them up might do then for simplicity sake the adult ego state in terms do they have a lot of presentation in the adult you know which is coming from the age that they are for you know from the age they are or do they have a do they present many from their younger self or child like state um so Eric Byrne will talk about doing a ego state analysis just to look at which ego state they spend most of their time in why that's why that's important of course is if they spend a lot of time in their younger self which often might be quite confused then problem solving may become may become quite difficult because they're attempting to problem solve without without the adult resources they've got around themselves yeah or they might be they might come from a younger self which is depressed which means and again often is the person's not able to access the adult resources around them to actually change yeah I think it's quite difficult on first meetings or the first couple of weeks to assess anything because all the defence mechanisms are going to be up do you know what I mean they're not going to be the true self in the room I don't think on that first session there's going to be a lot of protecting themselves against you because they haven't got a clue who you are basically to start off with well Eric Byrne used to say you know and I'm sure if he was here probably say I'm going to answer is probably in the first two three four sessions you can have a hunch yes yes definitely from an intuitive place yeah I think he's actually said in his first book he might take up to 20 sessions to get a more accurate ego state yeah and I think this is the difficulty with psychotherapy when people criticize it and say that it takes a long time you know to do anything the reason why is you are working with and through all the defence mechanisms and survival mechanisms and everything to get to the authentic person and that's hard yeah yeah and also it's true and accurate so you know you might want to say the first sequence of the first stage of a psychotherapy process you might want to call the defensive stage yeah yeah that's how I see it when people come in there's usually some sort of a front or a barrier or whatever it is even though they've sought you out they're on the back foot and they're on the defensive so some people might see the first stage of a psychotherapy process working through working collectively through people's defence processes yeah so that's an interesting one isn't it it doesn't always have to be you know there's different ways of looking at the first stage I think that that's too and I think I think you can work through people's or at least work towards understanding or working through whatever phrase you want to use people's defence systems and still be building up a working alliance yeah together yeah yeah and it's not about you knocking them down forcibly it's about them kind of relinquishing something and yeah not needing them as much oh I see the first stage very much about and is observational in other words noting those defence systems and allowing those defence systems to play themselves out because unless you do that two things are going to happen one you won't see how the script being played out yeah yeah secondly if you hammer on the door about people's defence systems uh you run the rest of them all running away anyway and you won't see them yeah um and thirdly I think it's really important to honor people's defence systems absolutely because that's how you've got to where they are they've they've needed them yeah absolutely so that then so it's not about knocking through them at all but it's I think just observing the defence systems honoring the defence systems and then that will take you into maybe if we want to compartment compartmentalize sequences uh which they're not too much you know an advocate form because I don't necessarily see psychotherapy processes as linear but for the sake of this podcast um that will take us to NTA anyway would be um often called a very long description name if you want but I think it's pretty accurate they'll be working on um deconfusing the child ego state which means working with the younger self or means exploring how the past affected the present no or means working with the unconscious part of the self any of those ways of describing the second state I think that um work with the unconscious part working with the younger part working with clearing up the confusion in the younger self are pretty good descriptions of the next day yeah yeah what do you say that I would I would agree definitely because if we take as red and I hope we can or the listeners can't tell you so red but you might not do of course which is fine as well um that's the early decisions that we're making about ourselves the world and other people shape how we want our lives today a zillion percent yeah so if those decisions if those decisions if you like are made from a dysfunctional or in a dysfunctional environment then they don't particularly help for healthy both sets today yeah so that's what I mean about working with the younger self or the unconscious self ta called deconfusing the child ego state going back to the history yeah look what decisions the person makes which help them then get through the you know what was going on absolutely yeah yeah it doesn't necessarily help them today yeah so for me one of the big things is to have an awareness around that yes definitely yeah yeah so that the person uh is aware of how things perhaps don't help themselves today yeah and of course they may feel a certain way but you're what you're talking about is helping people have an adult awareness so even if they feel a certain way it doesn't mean it's particularly healthy today yeah so that's what you mean isn't it absolutely yeah yeah and you know it's it served its purpose it got you to where you are now but you're not that child anymore you're an adult and you've got a lot more arsenal in your pocket so to speak that you can use absolutely yeah it's the feelings that it evokes I think that bring the awareness to light that's right so you know I think a focus of the second stage is helping the person make connections in past and present yes yes which is really the major focus at this stage I think we call it de-confusing the child at this day whether we call it work with the younger self whether we call it work with the unconscious I think it's about me helping the person make connections in past and present of being aware of that yeah absolutely and then the last stage I presume he's just bringing it all together and what we can do about it uh the third well actually four stages okay but I know what you mean the next stage yes so the next stage I think is once they've made connections about past and present how do they then put a new script on the road they've done the script analysis they made the connections yep yeah yeah yeah I see next stage is about making new re-decisions if you like yes yeah so that's what I see is the next stage so being aware of the connections and moving then to making new decisions which are more healthy and letting go of the not so healthy decisions so they could put a new plan or script on the road yeah now that's a lot of work that's you know the first two stages I'm not saying the first two stages aren't but if you get to get to the third stage where then they've made the connections and they now understand that or have a desire to move to or have a motivation to move to a new script it's a very big jump it's like I think one you get to the stage where they've got a cognitive awareness or even awareness from their feelings but then to make these new decisions is a whole nether stage I think in the psychotherapy process and many techniques which we may or may not have gone through in these podcasts which helps a person make these new re-decisions but to let go of their old script or their old decisions which had been with them such a long time and form was probably part of their identity is no mean feat and usually very scary and overwhelming for the person absolutely yeah and I think one of the things I often think about is that it's all done out of awareness and suddenly you've brought it all into their consciousness that these are the the decisions that they've made and this is how the past is affecting it all and it's it's difficult to let go of something that is an unconscious thing that you're doing I don't I don't know that I'm acting on my script I just make decisions you're right you're right Jackie but you know you're right I'm not taking that away seriously but you're right but I think that in a the sort of process we're talking about here I think that in the second stage they've made a lot of cognitive awarenesses yeah past and present they've made those connections yeah and through the work that you do with your client as they make those cognitive awarenesses which hopefully hopefully get based up feelings as well but anyway expression of feelings as well they've realised the connections they talked about the new decisions or what could go in this place so they have so they start to have that awareness then they need to go to third stage of letting go of this old script which I'm saying is really not so easy because it's built up with their identity I I think if they've done the second bit which is a cognitive awareness process so they know where they're heading even though it's not easy work they at least have a contractual direction they're going to yes yeah yeah and with the support of you in the therapy room and you know being able to practice it and then come back and and all that sort of stuff it's doable of course it's doable but it's not easy no and it really isn't because I said as I'm saying really it's those decisions have served them well yeah for a lot of their life it forms part of their personality constructs and identity and even though they may cognitively realise or even have a desire to let go and change parts of these destructive processes it's not easy to let go of the way that you've thought felt and behaved many many times before it's not easy to stop habits we know that don't we yeah in fact it's the most challenging part of a therapy process actually yeah me too when we get to change when we get to the part where they've made these awarenesses they know maybe a little bit whether heading but they find it so hard to do and I can remember when I was starting to make those changes when I was going through my training and the therapy process and everything is having a real sense of impending doom sometimes and a proper wobble what I would call a wobble and not really knowing what that was about other than something was shifting something was changing and I couldn't quite put my finger on what it was and do you know what kept you in therapy that time because if you had an impending sense of doom the way you're describing that it's then I believe violence some clients run yeah I think for me because I was doing my training as well as going through personal therapy so I think I had some understanding of this is normal this is this is part of the process even though it feels really uncomfortable and at times I can remember it being quite scary but I knew it was part of the process which I think is why I like TA because it's educational you know I talk to my clients about the wobbles and that feeling that something just isn't quite right taking your hand off the steering wheel do you know what I mean you need to really focus on that momentum of instilling the new values and new rules and new everything that you've got I had a bond recently that got in touch with me and I think it was from about 15 years ago and I've had this couple of times by the way but I'm just thinking of this person and she'd included me in a book she'd written a book she'd written was the therapy or some of the therapy she did with me and I'm just thinking about it now and it was very deep work and often two times a week and being in a group towards the stage that we're talking about and if I was I'm sure that if I was to ask her what kept you coming to therapy in the very difficult times we're talking about I am certain she would say you yeah and I think it's the relationship which holds and contains the whole process which the person can hold on to and feel anchored to get through these challenging difficult times yeah it is it's that anchor yeah and I know you went therapy but I also bet my bottom fellow whoever you would your therapist it's that relationship you know which probably are you trusted enough to be able to steer yourself through difficult times without that therapy is very very difficult yeah and may not actually happen because you're probably what you have to have you have to be able to lean on the therapist and that's why the first stage of psychotherapy which is building a working alliance getting the trust established having a genuine and sincere relationship where you can lean on your therapist in a dependable way is so vital without that that that structure is not there to be able to do the therapy that's needed yes yeah when I think people go or may never even go into the third stage because they know they haven't got a dependable other person yeah be able to go there with just teeter on the edge of it yeah yeah so this stage of letting go of destructive behaviors letting go of destructive habits making new decisions putting healthy scripts on the road leads us to the fourth stage uh which I I would call several words we can say integration putting it all together let's call it integration as I mean we'll say the fifth stage of determination then so it's five stages let's say the fourth stage might be all the integrating stage which is you've made all these new redecisions you've let go of many of the destructive behaviors you've got a more healthy script but you know what you now got to practice it yes you've got to test it out and that's what it is it is practicing and testing yeah and you need to do that with your therapist yeah I believe because it's too difficult to do it on your own the people that might leave therapy after the fourth stage would have just described without doing the integration bit with the therapist often leave therapy at a time where if they don't go through the next stage of doing their therapist and integrating them they're actually in a situation which usually is like the history which is being alone again and not supported and having to attempt to do what is what is very hard in many ways by themselves yeah so I need to do this integrating testing process with a supportive dependable person that is witness to their journey yeah I believe yeah absolutely because it can be another excuse me another form of sabotage if if they're you know they leave at that point because they're not going to have that safety and security in order to practice what it is that they're doing and it can just be a way of self-sabotaging and not making the changes couldn't agree more once that's all happened the fifth that the fifth stage have I said we've to which is yeah which is terminating and ending the therapist the whole process and of course that might take initiation by the therapist because the client who's trusted you and having the others gone on for a long time um so things they might not know when the right time to end they may need the help I think of the therapist to have a healthy supportive ending and there may be a person of course who's always had unhealthy endings in the first place yeah so I think it takes the co-creation of two people to move through the termination yeah yeah and for me it's them knowing that I'm not going anywhere and that I will still be there because yes with the they've sorted out you know the the life script and the the fundamentals of it all and and the life is going quite well but then life has a wonderful way of throwing us a curveball every so often so it's not that something might happen and they need to come back again you're right so if we recap recap those sequences or stages do you want to do that or shall I you go for it yeah so the first stage we've called um let's call it developing a worker line so I quite like that yeah and in that stage it's about contractual theory script analysis maybe some ego state analysis building up trust building up that solid secure base where two people can start their journey together that then leads on to what some people might in TA call de-confusing the child ego state stage I'm going to call working with the younger the younger self if you like and helping the person being aware of either confusion often in the child ego state if you want to put it that way where they have difficulties in accessing adult sources another way of looking at is sorting out terminations they may feel they're in their child but they're actually in their adult yeah it might feel in their parent ego state but actually in an adult ego state so sorting out when they know where they're in different parts of the south and helping building up a more robust adult in the here and now and I like what you said actually working through the defensive well not working through the defenses but helping them understand and being aware of their defense systems in a sort of honorable way yes yeah then we go to the third stage what do we call the third stage I think we call making connections didn't we was that new new re-decisions oh yeah fourth is re-decisions yes first stage is third stage is making connections and helping to make connections and how the past affects the present and we've started that already in the second stage but I think we're really now starting to firm up the connections between past and present also in the third stage though we're calling connections often what comes here of course is working with the parent ego state and the dominant toxic narratives but I still think the focus is to help the person make connections between the disconnected self between the parts of themselves they've cut off to survive connections between past and present I think that's all in the third stage and then from that we then move on to when we sorted out taking ownership of the parts we've cut off and brought them back in if you like or and we've done some of the desensitization around the parent ego state and work more to a unified whole we then move on to I think making new re-decisions let's call it the re-decision phase yeah where we'll start to make new decisions and let go of some of the unhealthy part of the script and once we've done that that moves us to the next stage which is the integrating stage and how you put it all together uh test out the new decisions that you've made into that's why I like the word integration it's much more of a whole process and when all that's done you move to termination that's how I see the sort of general sequences of an overall psychotherapy process yeah so it's not just a beginning a middle and an end I think we've got up to about seven stages there above yeah I mean we could yeah people I often talk about beginnings middle and ends but I think the middle is the I think the beginning and we'll stretch out the beginning could be the first two stages the middle stage could be third and fourth and then the end could be termination you know so you're correct the stage is within the middle the beginning middle and end but if you go through all that it's about it's quite a in-depth comprehensive you know journey absolutely absolutely yeah where we're witnessing you know transformation yeah every step of the way yeah that's been really good Bob yeah people have liked that and it's often if you went on a training program to be a psychotherapist you may take four years to learn how to do that and longer because you're continually learning oh all the time I mean I I put some of my thoughts down in this podcast which is half now and then 40 minutes and then but uh but of course it's just a very overall snippet but I hope it's been useful anyway yeah definitely so until next time Bob when we'll be talking about troubles and triumphs in the therapy process oh I'm not really a narcissistic person but I'd quite enjoy celebrating triumphs until next time Bob speak soon okay thank you you've been listening to the therapy show behind closed doors podcast we hope you enjoyed the show don't forget to subscribe and leave us a review we'll be back next week with another episode