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# Transactional Analysis as a systemic

constructivist approach
Abstract
To work with organisations means to work with living systems. Therefore, it is
essential to have a map, an overall concept that deals with living systems.
Various concepts of constructivism and other systemic approaches provide such
a meta concept. This article provides a summary of the seven key issues of
systemic and constructivist approaches and a consideration of how they fit
together with transactional analysis. The reader is guided through key issues
with the help of a case study. Readers are invited to think about new own ways
of dealing with the situation as a consultant. The final section contains a
practical recommendation for systemic working with TA on three levels within
the context of organisational consulting.
The systemic constructivist Model
Working with human systems often resembles walking in a jungle. You never really know
what will happen next when you cut a branch to seek a way through. The jungle, in the
same way as a human system, does not represent a conservative mechanical Newtonian
system, where easy soluble equations are useful to calculate reactions as a function of
causes in time and space.
Rolf Balling (2001) once expressed this nicely during a seminar: The difference between
living and mechanical systems resembles the difference between kicking a stone and
kicking a dog: With the stone you can exactly calculate the trajectory, if you know the
variables (power of kicking, mass of stone etc.). With the dog, you are not able to predict
exactly if he will fly, bite, bark or run even if you know a lot about the dog. You can
only calculate probabilities. You can for instance predict that he will probably bite you if
he doesnt know you and is hungry.
Living systems as complex systems are also described by Vester (1988) and (Drner
1997). The characteristics of living systems are summarized as follows:

unpredictable: the amount of data is too big to draw an exact prognosis (this is
for example the problem with weather reports)

networked: everything is connected with everything and you dont know exactly
where or how

dynamic: before you can understand and analyse all parts of the systems, the
system has already changed

not transparent: you cant measure all the parts, some remain invisible

undeterminable: there is no linear causal dependency, and chaotic, nonstochastic effects can occur
Understanding the significance of these factors is vital for people working with human
systems. Therefore, systemic thinking long ago found a place in family therapy (Minuchin
1978, Imber-Black 1988, and De Shazer 1991) and was even spread through the
different approaches of family therapy into other fields of counselling and consulting. A
very important outcome of systemic thinking is the inclusion of all the components of the
system in question. Worth mentioning here are, for example, approaches like The
Learning Organisation (Senge 1990); Appreciative Inquiry (AI), Open Space, Future
Search Conferences or Real Time Strategic Change, all of which were reviewed by
Holmann & Devane (1999) Another approach is the comprehension of Knigswieser &
Exner (1999) of systemic interventions. Also in Biology and brain physiology, newer
research confirms systemic thinking (Roth 2000, Spitzer 2000).

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## Systemic constructivist thinking in Transactional Analysis

This article aims to draw the attention to the implicit and explicit systemic constructivist
parts of TA. TA contains so many basic systemic constructivist assumptions that in fact
TA could be called a systemic constructivist approach itself. This is mainly because TA
was not only an individualistic but also a social approach from the very beginning. Eric
Berne himself was influenced by cybernetics. He was acquainted with the founder of
cybernetics, Norbert Wiener, who himself was acquainted with Heinz von Foerster
(2002), a major contributor to constructivist thinking. Even though Berne sometimes
tried to calculate social intercourse in a more linear way (Game formula), his basic
assumptions are process and system oriented. Barnes (1997) pointed out that Bernes
work drew on many of Batesons ideas (1979). This included epistemology (the way of
understanding), his cybernetics (the study of communication) and second-order
cybernetics (cybernetics of observing systems). Bernes systemic constructivist thinking
cumulated in his focus on interdependencies between society, culture, families and
persons (1964) and upon the structure and dynamics of groups and organisations (1963,
1966).
Additionally, much systemic, and especially constructivist thinking has been integrated in
TA therapy and counselling over the years. To begin with, the Stamford Papers (Loria
1991) present a range of these ideas. Later Allen & Allen wrote about constructivist TA
(1993) and the consideration of scripts as constructed narratives (1995). Allen (1993)
also worked further on crossing the boundaries with physics. Loria (1995) integrated the
Structure Determinism of Maturana & Varela (1998) into script analysis. Kennys (1997)
work on constructivism also shows deep influence of Maturana & Varelas (1998)
Structure Determinism and Kellys (1995) Personal Construct Psychology.
Yet not everything of TA, especially in the organizational field, is a priori systemic. There
are some important aspects that have been added later from the systemic approach
(Balling 2001). These where not included in early analytic or relationship oriented TA
approaches.
Modern organizational TA practice
Organizational work today meets the challenge handling an organisation as a client,
designing consulting processes in the form of intervention architectures in big projects or
putting more emphasis of role definition and positioning in the organization.
Using a case study, this article will show how TA fits with systemic constructivist thinking
to meet this challenge. In doing this, the quoted TA concepts are not explained
comprehensively for a deeper understanding I recommend Stewart & Joines (1987)
and their bibliography.
The case study
Imagine that the CEO of an information systems company calls you for help. He wants
you to run trainings about stress management for his employees. He explains that they
would need input on assertiveness skills, priority setting, and self-management methods
for their work. Imagine you are the consultant: What would you do at this point? What
would be your next intervention?
Let this example guide you through the article. The aim therefore is not to provide you
with a solution for this case but to support a reflective attitude and to enlarge your
possibilities thinking in systemic ways. Give yourself time to think about the example or
your own examples as you read the following key issues. Which ones do you find useful
for your work? Additionally, at the end of each key issue a reflection on the case study
will give (Fig. 1: Summarized application of the seven systemic constructivist key issues)
options for dealing with the possibilities of the example.

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Seven systemic constructivist key issues for organizational consulting and how
TA fits
Systemic and constructivist approaches can help us to find a way in the jungle, to
understand the phenomena we observe.
1. Holistic Thinking
The origin of the word system is Greek and means, to stand together. Imagine you
stand in a crowd and everybody is touching his neighbour. What do you notice? It is
like touching yourself. To think systemically means to include the observer at any time
(Von Foerster 2002). In non-trivial systems, which are analytically not transparent
(Von Foerster 2002) there is no mechanistic linearity. Cutting an elephant into two
halves does not result in two small elephants. Like touching a mobile there are
interdependent reactions. Everything is connected. To understand a part, you have to
see the whole. Science even postulates an invisible connection between biological
organisms through morphic resonance (Sheldrake 1981). There are many approaches
for integrating different areas of study into one theory (Wilber (2001). Capra (1987)
aims to reconnect physics and mysticism which were separated into two different
parts of the world after Plato.
TA is a holistic, teleological approach, which looks at the whole mosaic of the system
and includes the context. True knowledge is to know how to act rather then to know
words (Berne 1949 in Stewart 1992, p.4) TA as an intuitive approach connects the
empirical and the phenomenological world. As Zerin (1995) mentioned, today there is
the growing challenge to integrate the epistemological methods of rationalism,
empiricism, and intuitionism.
In systemic TA, we integrate the consultant as a part of the picture. Every interaction
is the combination of stimulus and response so the way the consultant responds has
great impact. Even the diagnosis is an intervention and is a part of consulting process.
In addition, many TA models consider the whole, starting with the basic concept of
ego states which are defined as systems, namely as consistent patterns of feeling and
experience, directly related to a corresponding consistent pattern of behaviour (Berne
1966). Other concepts are the three and multi-cornered contract, role theory, group
diagrams, symbiosis or the concept of script as a plan for a whole life span.
Considering the case study, it is helpful to explore the whole mosaic, ask questions
about the context and consider yourself as part of the picture. Why is it you whom the
CEO calls? What are his implicit expectations or hidden agenda?
2. Self-Similarity
Fractals, discoverd by Mandelbrot in 1975, are an important part of chaos theory.
Fractals are patterns in which the same pattern reoccurs on every level, from the
microscopic level to different steps of the visible structure. One part resembles both
the whole and other parts. Such fractals are for instant represented in a fern, a
cauliflower or a conifer (see Fig. 2: Fractals of a conifer).
TA models resemble fractals. From one transaction as a fractal, you can hypothetically
draw conclusions about the whole communication. The phenomenon of fractals is the
underlying mechanism of th phenomena of both intuition and parallel process.
The other way round, TA models are interlocking, so you can say script include games,
games include transactions, transactions include ego states and vice versa: from the
expression of one ego state, you can draw conclusions as to script issues. So it is
possible in one statement to build a hypothesis about the culture and get a feeling of
what it smells like.
In the example, the CEO may say The employees do not find the time to think about
the satisfaction of really important customer needs. From this you can make the first
tentative hypothesis perhaps about drivers (hurry up) or injunctions (do not think or
do not be important) or to passive behaviours, discounting etc. Of course further
questioning is important, for example about patterns of problems and problem solving.

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## 3. The Idea of Circularity

The behaviour of a system attains stability through feedback circles. Those systems
are called operationally closed systems (Luhmann 1992 , Rasch 2000), in which the
elements are coupled recursively with themselves (output equals input). The
circularity of communication (Bateson 1972, 1979; Watzlawick 1977, 1993) often is
illustrated with the familiar chicken and egg problem. In complex systems, there is
no such a thing as a guilty person. Operationally closed systems exist only through
interaction. This is called structural coupling (Luhmann 1992). Only the interaction
gives the system identity. Knowledge is gained through the construction of the world
by the process of interaction, finally of living (Maturana & Varela 1998).
TA concepts often show self-reinforcing circular systems. The frame of reference is a
filter, which only lets through that which matches your thinking, attitudes or feelings.
Script is defined as a life plan made in childhood, reinforced by the parents, justified
by subsequent events, culminating in a chosen alternative Stewart & Joines 1987) a
very self-reinforcing system. Another more visually clear example is the racket system
(Erskine & Zalcman 1979), understood as a vicious cycle of script beliefs, scriptguided behaviour and reinforcing experiences. Other circular self-reinforcing systems
are, for example, games, the drama triangle or the miniscript.
Within the example of the case study, you may look for stabilising context factors for
the current behaviour and the preferred outcomes. You may ask about previous
approaches solving the problem and which of them have been successful or
unfortunate.
4. Subjectivity
Radical constructivism postulates that there is no ontological truth (von Glasersfeld
1992, Segal 1986, Hofstadter 1985, and von Foerster 2002). We construct our reality
through our perception, our thoughts and our action. We can invent any reality. Our
reality construction is our responsibility. We therefore choose what we perceive, think
and do (Watzlawick 1977, 1993). Our words change our perception and if we change
our language, we change our reality (Luigi Boscolo 1993 in a Seminar in Orta San
Julio, Italia). Metaphors construct our reality (Simon 1996). Therefore, it is important
to bear in mind that concepts are also our own inventions and that the map is not the
country.
On the one hand in TA the assumption of subjectivity is explained by the concept of
frame of reference: our perception, attitudes and prejudice determine our reality.
Additionally script beliefs, drivers, contaminations, exclusions, life positions, discounts
etc. govern and often distort the perception of our world. On the other hand, the goal
of counselling in TA is autonomy. Autonomy is characterised by the lack of such
distortions and by three capacities (see Stewart & Joines 1987, p. 266):

## Awareness = the capacity to perceive things as pure sensual impression without

filtering our own experience to fit parental definitions.

## Spontaneity = the capacity to choose from a full range of options in feeling,

thinking and behaving

Intimacy = the capacity to share feelings and wants openly with another person
Autonomy means that we are in charge of our feelings, thoughts, behaviour and
decisions.
Applied to the case study you may examine your own autonomy. You may consider
yourself as your most sensitive and important instrument. Be aware of your subjective
quality and therefore aim to use all your capacities. Be creative, and take
responsibility for your contribution to the problem and the solution. You may reflect on
your preferred ways to respond to the clients orders or specific problems.
Alternatively, you may focus on the way the CEO constructs reality and plan to change
his frame of reference in a more problem solving way.
5. From structure to process
In the old Philosophy perinea, the focus was on the connection between form and
emptiness. In physics Einstein discovered that matter is equivalent to energy and put
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in the formula E = mc2 (Energy equals mass times the square of the velocity of light).
Schmid (1994) picks up this idea in his book Where is the wind when it doesnt
blow? Dynamics of processes are often more important than structures. To
understand a river it is not helpful only to analyse the water, ground, sand, stones etc.
but also the dynamics, how it flows.
Additionally, Heisenberg proposed in his theory about the uncertainty relationship
that the more you try to analyse structures on a subatomic level the more you only
get statistical probabilities of energy distribution. This provides the basics for
overcoming the old matter-mind gap.
The principle of uncertainty relationship also found a place in the world of business.
Most clearly, Davis & Meyer (1998) point out the growing importance of electronic
networking, which speeds up business processes, e.g. on time delivery, up to a
blurr. That means that intangible values like service, information and emotion
become the most powerful resource. For example attention becomes more important
for organisations than property.
TA is in its origins very focused on energetic patterns. The model of ego states
originated as a theory of energy distribution. TA often uses patterns, which describe
processes with a defined beginning and a defined end, for instance games, which
describe repetitive patterns of social intercourse characterised by ulterior transactions
and with an ending of bad feelings. Script is another example. In his considerations
and models about group dynamics Berne (1993) focused on energetic and structural
pattern.
Patterns which occur in work with organisations are clearly described by Schmid
(1994), for example quicksand systems, which are characterised by interlocking
redefinition transactions or the dilemma circle which can be understood as a awkward
frame of reference in form of a vicious circle (denial struggling exhaustion
desperation).
In dealing with systems, one approach is to divide these into two categories: fixated
or chaotic systems (idea of Balling, unpublished material). This division leads to two
directions of interventions, which you may apply to the case study. If a consultant
encounters a fixated system, which is characterised by strong boundaries and clear
rules, she/he can use techniques to enlarge complexity, e.g. to extend the frame of
reference, to give attention to influences of the context, to provide with overlapping
maps or to irritate reality habits by paradox or other interventions. If the consultant is
met by a chaotic system, which is characterised by fluent reality assumptions, which
makes it over complex, she/he can use techniques to reduce complexity, e.g. by
contracting, providing a focus or the use of clear models.
Additionally, in the case study you may use TA concepts as checklists for potential
patterns of energy distributions, for example concerning the underlying (script) beliefs
or interlocking transactions between CEO, line managers and employees. Is there a
strong and fixated idea about problems and solution? The other way round, is the
stronger flow of energy directed towards confusion and redefinition?
6. The focus is on effects
In complex systems, it is often not possible to evoke linear effects. Often causes and
effects are not necessarily directly related (neither in space nor in time) not even
problems and solutions (De Shazer 1991). So the question rises: Where is the
greatest leverage? (Senge 1990) For instance has the personality of one leader great
impact on the development of the employers. Small changes may have great effects
but the most effective procedures are also the most inconspicuous and most
unspectacular ones. This is the so-called Butterfly Effect: a butterfly in China moves
its wings and causes a tornado in the USA.
Also in the unpredictable, indeterminable, dynamic systemic jungle paradoxical or at
least not directly understandable effects occur, for instance homeopathic effects:
deterioration often advances improvement. On the other hand, one can experience the
effect, that the effort to accelerate things often slows them down.
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## An approach seeking principles in the chaotic development of evolution is the concept

of attractors (Wilber 2001). Attractors have the effect of orientation. As a kind of
vision of what could be, they are an inherent force for development. Hillman &
Ventura (1992) adressed this also in their psychotherapy-critical approach. Aiming at
the redefining of hurtful experiences, they refer to the invisible field of germs and
growing plants, which is like a presentiment of their future form. They assume a
similar mechanism in the development of human beings who chose in anticipation of
their future task certain experiences, which are sometimes hurtful but also
strengthening and preparing.
In its roots TA is a pragmatic and resource oriented approach. There is a saying, which
is attributed to Berne: Let's first heal and think later.
Although there are approaches in TA, which focus on the linear assumption that early
childhood experiences cause disturbances in adult life, there are also tendencies to
loosen this strong connection. For example Allen & Allen (1995) mention: If we
conceptualize the script as created, reaffirmed, and recreated in the present, then we
can conceptualize it as potentially highly changeable over time. (Allen & Allen 1995,
p. 330). Games possibly originate in script patterns. Nevertheless, often they are
nothing but bad reality habits with no secondary gain (Schmid 1994). In systemicconstructivist thinking, it is even irrelevant to look for the truth of concepts. The
relevance divulges from the helpfulness of specific assumptions for specific clients in
specific constellations and situations. Concerning the use of script, it often is more
helpful to look at the bright side of difficult experiences (see Hillman & Ventura 1992).
The theory of attractors (Wilber 2001) resembles Bernes assumption of Physis as
an inherent transformation force. For consulting in complex living systems it is very
helpful to go with this force and adopt the attitude, Dont stop the river, it flows by
itself.
In TA, a central attitude is to focus on the leverage effect. Eric Berne often referred to
Occams razor. William of Occam was a 14th century philosopher who recommended,
Entia non sunt multiplicanda praetor necessitatem , which translates as Entities (in
a theory) are not to be multiplied beyond necessity (cited in Steward 1992, p. 119).
Spoken in a more prosaic language Jack Dusay said in the TA-101 video of ITAA: It
is vain to do with more, what can be done with less a proverb that is shortened to
less is more in nowadays procedures and means that we cut things down to the
main points.
Many TA concepts provide us with the insight that often what seems to be the solution
reinforces and even generates the problem. For instance inherent in the idea of drivers
or script illusions people can become aware about their psychological filters in problem
solving with the help of these concepts.
Concerning the Case Study for example a miniscript belief of I am going to be okay, if
I hurry up probably leads not to experience time as a rich resource but to more
stress. On the other hand, there is possibly a leverage through coaching of the CEO.
His emerging attitude of My people are competent and reliable enough for me to give
them the necessary resources could lead to a resulting behaviour of more intensive
communication and commitment and ultimately flow into the envisioned results.
7. The chosen logical level is crucial
Bateson (1972, 1979) raised the question of how to find a difference, which makes a
difference. Solutions within the system (change of internal states within an invariant
system) are called first order solutions, solutions which overcome the system and
build something new (changes which change the system itself) are called second order
solutions (Watzlawick 1974, De Shazer 1991). Wilber (2001) makes a difference
between homeostasis (the possibility of a system to stay stable), translation (the
possibility of a system to vary within its boundaries) and transformation (the
possibility of a system to change itself).
In systemic TA, we consider different levels, e.g. person, interaction, development,
groups, systems. We look at these levels in hypothesis building, choose between them
in search of the greatest leverage and we can switch between the levels while having
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## the others in mind. As an intuitive approach, TA is able to switch between

microanalysis and a meta perspective. Especially in work with organizations, we
consider different intervention levels, different roles and multi-cornered contracts.
These approaches even result in the construction of intervention architectures in big
projects (Knigswieser 1999).
On the level of models, in TA a main contribution to level-oriented thinking is the
discounting matrix (by Mellor & Schiff 1975). This model differentiates between the
discounted area (discounting of self, others or context), discounted modes
(discounting of existence, significance, change possibilities, personal abilities) and
discounted types (discounting of stimuli, problems or options).
Concerning the case study, it is helpful to decide whether for example coaching of the
CEO (personal level), training of the employees (skill level), team development
(interaction level) or a workshop of strategic planning (system level) would be most
likely to bring about the wished outcomes. Often the decision depends on negotiated
roles and contracts.
In Fig. 3: Seven principles of TA as a systemic constructivist approach, the comparison
of systemic constructivist principles and the transactional analysis approach gives you
an overview and summary of this chapter.
Conclusion: Three levels of TA application
Within the seven key issues, you can find some implicit ways to apply TA in the
organizational field. Mainly there are three ways, which are extremely helpful to consider
before you start an intervention (according to Rolf Balling, unpublished): 1. Meta
concept, 2. Self-reflection of the consultant and 3. In contact with the client.
1. Meta concept
The basis for our actions, even before we contact clients are our attitudes and our
values. To belong to a TA association provides us with an ethical and cultural
framework, which influences our frame of reference, our way to look at the world.
2. Self-reflection of the consultant
TA is an empirical and phenomenological approach, which combines observation with
intuition and conceptualising (Stewart 1992). As an observable theory it is effective,
easy to replicate and testable. As shown earlier (Kreyenberg 2001, 2002), the
consulting process (observation diagnosis intervention planning intervention
evaluation) is mainly guided by the comparison between intuition and concepts,
resulting step by step in further hypothesis building (see Fig. Fig 4: self-reflection
process of the consultant). For this mostly internal process of the consultant, TA
provides us with a great benefit: a wide range of concepts on the one hand and
intuitive procedures on the other. Here concepts are guidelines in complex situations,
which help us to find the most useful approach for the client.
3. In contact with the client
The third supportive power of TA lies in its most obvious part, the style of consulting,
intervention and method experienced by or shown to the client. Of central value is
also the explanation or teaching of concepts. Easily understood, most concepts are
suitable for the client and can be naturally adopted using colloquial language.
Let us look at the case study as an example for the three levels:
On level one the consultant has a holistic systemic view, ethical and quality
standards, for providing best professional service, not to harm or exploit the client
but to enhance development and autonomy, work on a contractual base, take
responsibility for the process beyond the termination of contract etc.
On level two the consultant reflects upon the given information, for instance with
questions like, What does the first contact feel like? What are first observations and
images? What would I like to do? To what do I feel invited? What could be good
questions for the client? What do I have to find out for the important problem solving
parts? What are first hypotheses? The greater part of the case study reflections at the
end of each of the seven key issues fits into this level.
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On level three in this early phase the style of consulting and first interventions are
visible for the client. After a negotiated contract, there might be further useful
concepts to offer the leader and/or the participants of a seminar, workshop, coaching
etc. These might be drivers, time structuring, stroking, life positions or cultural script
and so on.
thinking and acting within the framework of TA, it does not claim to be complete. I am
glad if it stimulated you to think about further options, and look forward to the
exchange of additional ideas.
Jutta Kreyenberg, as a Psychologist and Teaching & Supervising Transactional Analyst is
the founder of the Institute for Coaching & Supervision, Southwest of Germany. She
works in the field of Organizations as a Consultant, Coach, Trainer, and leader of
workshops. Her main themes are Coaching, Management and Leadership, Conflict
Management, Team and Personality Development.
Jutta Kreyenberg, Institute for Coaching & Supervision
Hauptstr. 44, D-67269 Grnstadt, Germany
Fon ++49 (0) 6359-92184
www.CoachingSupervision.de, info@CoachingSupervision.de
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Fig. 1
Systemic constructivist key
issue
1. Holistic thinking
2. Self-Similarity
3. Idea of circularity
4. Subjectivity
5. From structure to process
6. The focus is on effects
7. The chosen logical level is
crucial

Intervention
Ask questions about the whole mosaic, the context
Draw conclusions from the fractal of a first stimulus to
first hypothesis about the problem and/or solutions
Think bout circular mechanisms which stabilize
problems and solutions
Aim to use all your capacities, be creative, be aware of
your subjectivity and take responsibility for your
contribution to problem and solution
Use TA concepts as checklists for potential patterns
Focus on the healing forces and leverage effects
Check on different levels, roles and contracts

Fig. 2

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Fig. 3
Key points

## Characteristics of the systemic

Pictures &
constructivist approach of organizational Metaphors
Consulting
everything is connected - to understand a
part you have to see the context
Cutting an elephant into two halfs does
not result in two small elephants

SelfSimilarity

whole

Idea of
circularity

## systems exist through positive feedback

circles
there is no such a thing as a guilty person
Concepts are inventions.
The map is not the country
You can invent any reality. It is our
responsibility which reality we construct
Structure follows process and vice versa
structures are patterns of stabilised
processes
often causes and effects are not
necessarily directly related
where is the greatest leverage effect?
Homeopathic effects
The try to accelerate often slow things
down

Holistic
thinking

Subjectivity

From

structure to
process
The focus is
on effects

The chosen
logical level
is crucial

Fern or
Cauliflower

## we look at the whole mosaic, we include the context

intuitive approach
the consultant is part of the picture (bonding)
The TA-models consider the whole, e.G. ego states,
symbiosis
from one transaction as a fractal you can draw conclusions to
the whole communication (idea of parallel process)

AB

## TA concepts often show self reinforcing circular systems

e.g. the frame of reference, racket systems, mini-script

## Our perception determines our reality: frame of reference

The goal is autonomy: to be free from distortions like script
beliefs, drivers, contaminations etc.; to be in charge of own
feelings, thoughts, behaviour and decisions
in TA the focus is on patterns, which describe processes, e.g.
games, script

E = mc2

butterfly
effect

## Where is the difference that makes a

difference?
You can either eat the cake or keep it
but not simultaneously

## TA is a pragmatically and resource oriented approach

Let's first heal and think later
Physis as an inherent transformation force: Dont stop the
river, it flows by itself
Use of Occams razor
Often the solution is the problem idea of drivers/script
beliefs
Ta considers different levels: person, interaction,
development, groups; e.g. Discounting matrix (area,
modes, types)
Differentiate between intervention levels and roles
(intervention architecture in big projects)

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Fig. 4
Observation

Evaluation
Intuition
Concepts
Hypothesis

Intervention

## Jutta Kreyenberg Hauptstr. 44 D-67269 Grnstadt

Diagnosis

Intervention
planning

page 13 of 13
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