How I Talk Myself Through My MS Journey Using Transactional Analysis

By Kim Dolce

4 min read

Many people with chronic illness benefit from practicing some form of psychotherapy. It can easily be added to drug and physical therapies, meditation, prayer, and other kinds of wellness practices.

The kind of technique I will be describing is an older psychotherapy called Transactional Analysis (TA). Created during the 1950s by Canadian psychiatrist Eric Berne, it is rooted in Freud’s original psychoanalytic theory that our childhood experiences greatly impact our adult lives. On the front end, it also ties in neatly with Cognitive Behavioral Theory (CBT) and mindfulness, two very popular, contemporary self-help tools.¹

How I utilize Transactional Analysis

I engaged in TA in my early twenties, and now at 64, I still use the basic concepts in two ways:

To sort out where people are coming from.
To sort out why I am behaving the way I am.

I find it easy to understand and apply to myself and others. Here is how it works.

Understanding the egos

TA determines the ego state of a person during a social interaction (transaction) as a basis for understanding behavior. In TA, there are three ego states: adult, parent, and child (kid). We are all in one of these ego states whenever we socialize, and we can shift between them as well.¹

The eventual goal of TA is to strengthen the adult ego state and use it to make the majority of decisions. Making the adult the executive ego state cuts short the amount of time and emotional energy spent on feelings such as anger and hurt. The result? A person that feels a lot more in control of the quality of their communication and life with chronic illness.^1,2

Examples of ego state behavior:^1,2

Adult: The adult provides facts and is non-judgmental. She exists in the present. This is the preferred executive state that mediates the conversation between parent and child ego states.
Child (Kid): The kid has been conditioned to respond to situations based on childhood experiences. She lives in the past. Subsets include the free kid, who is spontaneous, creative, and fun. The adapted kid, who is anxious to please and be liked/loved. The rebellious kid, who is the flip side of the adapted kid and acts defiant, fussy, and mad. For example, whenever I go to a doctor's appointment, I am asked a lot of questions. My rebellious kid is impatient, fidgety, and petulant, and wants to resist. The last subset is the scared kid, who has stage fright, anxiety about taking tests, etc.
Parent: The nurturing parent and critical parent occupy this ego state. Like the child, she lives in the past. Her responses to present situations are shaped by early interactions with parent figures who modeled the behavior she now uses.

When can I apply this practice?

This kind of analysis can be applied in two ways: in conversations you have with others and in the interior transactions taking place in your mind between your adult, parent, and kid.^1,2

Think about the daily gamut of emotions you feel about your discomfort and limitations, not to mention dealing with insurance companies, doctor appointments, pharmacies, strangers, family and friends, and more. We are no strangers to aggravation, frustration, impatience, hurt feelings, disappointment, and a pervasive feeling of helplessness.

Transactional Analysis and MS

I can easily apply this to the ongoing interior conversations between my own ego states in reaction to my chronic illness symptoms, doctor appointments, and other stressors related to getting a lot of medical care. My adult, parent, and kid engage each other constantly from the time I wake to the moment I turn out the light and go to bed. And even beyond that, which is one reason I have sleep problems.

Communicating with your doctor

One example is, that doctors can be in their “adult” when listening to symptoms you are reporting, then tell you what they think is going on and recommend a course of treatment. You, in turn, might listen to your adult by responding with: “I am open to and curious about how the change in treatment might affect me, so let’s do it.” Or, “I’ve already tried something similar, and it didn’t work for me in the past. I’m open to other suggestions, though.” Or, you might react in your “kid” by saying “I don't want more drugs, I hate swallowing pills!” What’s more, doctors can, along with their adult, also either listen in their nurturing parent ("I’m so sorry you’ve been uncomfortable") or in their critical parent (“You’ll not get any opioids from me, you drug-seeker!”).

Supporting others with MS

In my role as a moderator on this site, whenever I read a patient's post about their pain, loneliness, and suffering — they are in their kid ego at that point — I will respond in my nurturing parent to comfort and support them. I might also respond in my adult ego state depending on the needs of the person, if they are looking for resources and need to find links to services and information, etc.

Treatment decisions

One thing I think most of us can relate to is drug therapy and how we feel about it. In my case, I swallow 16 pills first thing in the morning, 2 in the afternoon, and 18 in the evening, for a total of 36. Some are vitamins, minerals, and other over-the-counter supplements that are necessary and can’t be skipped. While my rebellious kid wants to run away and chuck the whole enterprise, my adult steps in and reminds me what they are for and how they benefit me. My nurturing parent is compassionate and understanding, and together with my adult, they soothe my kid and offer a reward for being a good girl and taking my pills.

We need to be in our adult ego state to determine what ego states others are in and to assess where our own reactions are coming from. This is why the goal of TA is to strengthen the adult ego-state, thereby using less energy on anger and pain.^1,2

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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Therry Neilsen Moderator & Contributor
Kim, thanks for the introduction to transactional analysis. Goodness knows I've used psychotherapy over the course of my MS journey, but it tended to be more traditional, more FREUDIAN, if you will! I stopped doing therapy when I found myself laughing and recognizing that I was regressing in support of my ego... But I especially like the simplicity of transactional analysis, and can readily see myself in the nurturing parent role as I moderate <a href='https://multiplesclerosis.net' target='_blank'>MultipleSclerosis.net</a>. I do tend to rely on my adult ego state a lot and I'm sometimes too quick to respond with some helpful information when what the writer needs is a good internet hug and a sign that they've been heard and BELIEVED. As always, I learned a lot from you, and please feel free to regress in support of your ego whenever you feel the need.
1. Kim Dolce Moderator & Contributor
 <inline-mention username="Therry Neilsen" user-id="4095618"/> Good advice, I shall make an effort to regress when needed 😀
Therry Neilsen Moderator & Contributor
For one thing, it's a great excuse for less than optimal behavior!
Kim Dolce Moderator & Contributor
LOL, but whenever I have regressed in the past, I've had my ass kicked! I should be careful about who is the other in the transaction.
Cathy Chester Moderator & Contributor
Excellent as always Kim, and very fascinating and useful. I'm going to work harder on my "ego" stage now!
1. Kim Dolce Moderator & Contributor
 <inline-mention username="Cathy Chester" user-id="4083596"/> Aw, thank you so much, Cathy! Always good to hear from you 😀
2. Kim Dolce Moderator & Contributor
 <inline-mention username="Cathy Chester" user-id="4083596"/> Aw, thank you so much, Cathy! Always a pleasure to hear from you 😀
tazz Member
Transactional analysis might be "old" but I believe it is still a really good way to deal with things. You don't need to get right into the depths of it to benefit, and I think it's a shame that it is far less recognised than it ought to be. I'm in the same age bracket as Kim Dolce and also first encountered it in my mid-twenties, and it was life-changing for me at the time. I have a rather dysfunctional "family", my father died when I was 19yo, and my mother was a highly skilled practitioner of emotional blackmail and guilt-trips (i.e. Masters Degree level!). These days I may have far more understanding of what contributed to and drove her behaviours (we are all imperfect beings just trying to do the best we can) but growing up with them and trying to be an adult while still having all the painful childhood buttons being pushed by her was, to say the very least, bloody hard, as well as being damaging to my adult relationships. An episode of severe depression in my mid-twenties had my GP refer me to a psychologist and he introduced me to TA - not in depth - we really only touched on the basic theories, but it made such a difference to me and my interactions with other people, and has done so for my entire life - in both work and personal relationships. I think the hardest part was the first couple of months, when adapting how you dealt with and reacted to situations and people was so front of mind and conscious, but then it all became internalised and a natural pattern of behaviour. For me it has disabled almost every one of those awful "buttons" that so many people like to push - the only negative I found was that people who operate by pushing buttons often just try even harder to provoke a response, but TA still helps you to stay grounded in the face of those efforts. As a stress reducer when things are tough, using a TA approach in relationships in both work and personal life can be really helpful - and we all know that stress is a major enemy for PwMS. However, once TA has become a normal way of responding in your life, you don't need to consciously use it - it's just part of you. For those who are interested in looking into TA further at a level which is accessible to the general population - the classic book "I'm OK, You're OK" is one of the easy ways to acquaint yourself with TA. It is still in print, and copies can also be found on eBay and through other sources of 2nd hand books. Try it, it's worth it - you're never to old to learn something valuable that improves your life and relationships. And you don't even need to read the whole book to benefit from it! https://en.wikipedia.org/wiki/I%27m_OK_%E2%80%93_You%27re_OK 
1. Erin Rush Community Admin
 <inline-mention username="tazz" user-id="4102606"/>, thank you for sharing this! I wish you hadn't experienced such serious loss and trauma at a young age, but I am glad you have learned how to cope and grow through TA therapy! Your information could be really helpful to other community members here. Thank you again for sharing! Best, Erin, <a href='https://multiplesclerosis.net' target='_blank'>MultipleSclerosis.net</a> Team Member.