A Tale of Two Healers

Eric Berne & Meyer Friedman
Transactional Analysis and Type A BehavioR

One of the most enduring and endearing gifts of Transactional Analysis is its malleability. This article is yet one in a long series of such articles where TA is compared to and combined with other approaches, thereby enhancing and enriching both. In this process it often borrows and gives, making for an extraordinary evolution.

Drs. Eric Berne and Meyer Friedman were peers though they might not have known one another.* One created Transactional Analysis (TA) and the other discovered the health damaging effects of what became known as Type A Behavior (TAB).

*(I have no personal anecdotes from Eric Berne regarding his newfound fame, but I do of Dr. Frieman. I mentioned to him one night that he was the most famous person I knew. He said, “I’m not famous.” I protested but he insisted. He was right. Lots of people use the label, “Type A,” but few could tell you who coined it. When he was recognized in public it was because someone heard his last name and presumed that he was Milton Friedman, the famous economist. He had many funny stories. The best was during the ﬁnancial meltdown of 1987. A camera crew rushed into the restaurant where he was lunching with a friend. Breathlessly they apologized for the interruption and then proceeded to ask him to make a comment on the state of the economy. Never batting an eye, he gave them a lucid answer. One can only imagine the scene back at the TV station when they discovered their error.)

At age sixty Eric Berne died of heart failure following a heart attack in 1970, a stunning loss for the people who were bound to him. At roughly the same age Meyer Friedman had the ﬁrst of his two heart attacks, saved in both cases by open heart surgery.

We will never know what further wisdom would have come from Eric Berne had he been given another thirty years of life. His mind was alive, and he was at the peak of his creativity. One thing is certain. He had more books left to write.

We do know the gifts that came from Meyer Friedman in his last thirty years dying just short of his ninety-ﬁrst birthday. During his lifetime he published over ﬁve hundred papers stemming from his medical research, one-hundred-thirty of them on the effects of cholesterol alone, most of them before age sixty. In the three decades following he published both of his books describing TAB.

They shared a common surprise in that each became a best-selling author, Games People Play for Berne and Type A Behavior and Your Heart for Friedman, making each of them household names for a short period. ** According to TA lore, Berne fretted whether his book would sell well enough to recapture production costs. As I understand it, he asked everyone in his weekly Seminar to agree to buy ten copies. Neither he nor Dr. Friedman imagined the public success that awaited them.

Coincidentally, they both proposed the importance of what they referred to as the “Three P’s.”* In Berne’s case they had to do with what he considered the three most important qualities for a therapist to possess: Power, Protection and Permission.

*(This is a bit of poetic license on my part. The concept of the Three P’s was put forth by Pat Crossman, for which she received the Eric Berne Scientific Memorial Award. Over time that fact is largely forgotten and the three P’s have become associated with Dr. Berne and his legend. And in my defense, Berne mentions all three blithely as his own on page 375 of Hello. 2 )

For Meyer Friedman they referred to “People, Pets and Plants.” He believed that to modify TAB (an urgency about time he called “hurry sickness” and an easily stimulated reaction he called “free ﬂoating hostility”) one had to invest in that which is living as an antidote to the sterile pursuit of numbers.

Both men were centered in San Francisco and each had homes outside the city, Berne in Carmel and Friedman in Sausalito. They had both served as medical officers during World War II, Berne in the European theater, Friedman in the Paciﬁc at a military hospital in Hawaii. And, obviously, the work of both shared the same initials: “TA.”

Eric Berne lost his life just months before I completed my preparations to move to California. I had hoped to meet him and perhaps study with him. I never met him, only his bereft and broken-hearted students and disciples. Two of Berne’s ardent adherents, Bob and Mary Goulding were my reason for traveling to the west coast in August of 1970. They became my teachers, my mentors and my friends. I know Berne primarily through them and their ﬁrsthand accounts.

I did meet and know Meyer Friedman. He interviewed me for a position on his staff of group counselors based at Mt. Zion Hospital in San Francisco in 1988. He was conducting an ambitious ﬁve-year study involving three thousand participants, randomly assigned to two groups. Fifteen hundred were to be in treatment for ﬁve years and the other half as a control group. The ambitious goal of that study was to see if future heart attacks could be prevented by helping people modify their TAB before they became ill from cardiovascular disease.

My ﬁrst introduction to TA was in 1969 at the Louisville Presbyterian Theological Seminary where I studied with my ﬁrst mentor, Dr. David Steere (later a Teaching Member of ITAA). I had been steeped in TA for more than twenty years when I had that initial interview with Meyer Friedman.

The two disciplines appeared to have no intersection on ﬁrst inspection. TA focuses on the origin of a person’s life, how they had been scripted by parental ﬁgures and other environmental factors. Eric Berne and those who followed were rigorous, dedicated and highly subjective and intuitive.

Chastened by the scientiﬁc approach throughout his career as a medical researcher, Meyer Friedman was objective in his approach. He developed statistically valid methods to assess the presence of TAB in a person’s life and an equally valid measure to conﬁrm the reduction of their TAB.

But Meyer Friedman was not entirely objective in his approach because, like Berne, he came to believe in the power of warmth, affection and unconditional affirmation (Strokes) as effective tools in the change process. He claimed that those counselors who had the greatest capacity to help people change were those with the most available warmth to convey, hardly an objective quality to measure.

Indeed, he told me in no uncertain terms that possessing a deep caring for the people in the groups I would be conducting was essential. He told me that if he discovered I was conducting the groups in a perfunctory manner to collect my fee and had no heart involved he would not hesitate to ﬁre me.

Eric Berne described the importance, the vital necessity of what he called “strokes” in peoples’ lives. A child who is given no caresses, no warm contact, no warm strokes or worst no strokes at all would not develop normally and could even fail to thrive.

Berne emphasized the value of stroking, even negative strokes as essential so that an infant’s spine would not shrivel. He proclaimed unconditional positive strokes to be the most life sustaining and healing. A person could get lots of stokes from what he called an “Internal Critical Parent,” but one goal of treatment was to replace that with an “Internal Nurturing Parent,” one capable of providing affection, warmth and affirmation.

Standing on the podium of his objective scientiﬁc purity Meyer Friedman also saw the need for genuine caring, the communication of affection to create transformative change. To heal and protect a wounded heart, he came to believe that one literally had to be exposed repeatedly to a warm heart so it could become implanted in the person. Both believed in the power of an internal nurturing parent. Each had a different way to describe it.

Each came to their discoveries by a different route. However, both had an important similarity besides their rigorous medical training at excellent universities and medical military service. They both read widely and not just in their branch of science. They had a passion for ﬁction and literature about the natural world. They knew the classics and the history of science.

They each published books early in their careers focused strictly on their ﬁeld of science. Berne wrote a book explaining psychiatry for the layperson (A Layman’s Guide to Psychiatry and Psychoanalysis, 1957) and Friedman on cardiovascular disease (Functional Cardiovascular Disease,1947). In each of those books it is difficult to discern the person who is to come, other than seeing the sheer intelligence of both. Neither book drew great attention outside their own disciplines not to mention that neither became a best seller in the popular market.

Their later books, though theoretical and scientiﬁc are peppered throughout with metaphor, poetic imagery and quotes from literature, ancient mythology and personal anecdotes.

Berne described his early studies about intuition while still in the military as World War II was winding down. It was through these observations that he derived the concept of the Child Ego State and TA was born. He moved on to discover and describe the Parent Ego State and the Adult Ego States.

In the same way Friedman was a keen observer, able to see things long present but never described. In his research work, he discovered the cause for heart attacks, the coronary thrombosis, a result made possible from his studies of cholesterol. Along with his other seven original medical discoveries, this one assures him a kind of everlasting fame, at least in the footnotes of medical journals in the future.

Working many years as a practicing cardiologist he had an intuitive awakening. Given the times, he saw far more males than females* suffering from coronary vascular disease. He was deeply and sorrowfully impressed by the number of widows who sought him out asking him to explain to them what had happened to their apparently healthy husbands who had died at such young ages. To this plea he had no satisfactory answer.

*(This fact bore out a belief that it was believed that women were immune to coronary vascular disease because of the “female hormone.” This has not proven true as women in the last half of the 20th century entered the workforce in greater numbers and were exposed to heightened levels of stress in that world. Sadly, heart disease is now the leading cause of early female mortality for women in western society. In a similar way the absence of coronary vascular disease in Japanese society prior to the 20th century led to the erroneous conclusion that their diet prevented the onset of the disease. That also proved incorrect.)

Then he gradually saw something. Just as Berne came to see repeated patterns of human behavior he came to call “Games,” so too did Friedman observe patterns of behavior. Having witnessed the premature deaths of more than four hundred patients he began to reﬂect on them as a group. He wanted to see if it was possible to discover the predictors of a possible heart attack.

To his surprise he found only one area of similarity among all his patients, living and dead. There were numerous differences. Some were overweight, others thin; some smoked, other did not. Some had high blood pressures others did not, the same with cholesterol levels. Some exercised religiously while others were couch potatoes.

There was only one factor they all held in common, at least all those who had been stricken before age of sixty: their behavior. They had all been afflicted with hurry sickness and easily aroused hostility.

Reviewing his own history, Dr. Friedman realized that he had been given a tantalizing clue prior to this discovery only he had not recognized it at the time. In a story that exists in TAB lore, a furniture repairman asked Dr. Friedman exactly what type of medical practice went on in his offices. “Why?” “Because the wear patterns on the chairs of your waiting room are radically different from any other waiting room in the building.” “How so?” “They are worn out on the front edge.” It was true and evident. Being undoubtedly time urgent, he hurried on and thought nothing more about it.

Later he realized it was a clue to the unique behaviors of people with cardiovascular disease. They sat eagerly on the front edges of the seats, not relaxed, but hyper alert. They had a “ready, set, go” posture, like a runner awaiting the starting gun.

As mentioned earlier, Berne helped process hundreds of GIs per day out of the army at the end of the war. This psychiatric review consisted of asking two or three questions before going to the next person. To ease his boredom, he created a challenge for himself.

As each man walked in identically dressed in army fatigues, he would write on a piece of paper his ﬁrst guess as to what the person’s occupation had been prior to being homogenized by the service. To his astonishment he had a much greater rate of guessing correctly than he had imagined could be possible.

He then decided to see if he could increase his accuracy by using his diagnostic skills. He waited until the end of the interview to make his guess. Again, to his astonishment the objective method was far less reliable than the subjective. Thus was his study of intuition born and the rest is history.

For years it seemed I lived in two universes. In the ﬁrst, with my colleagues I was conducting Type A groups, classes for the Institute. They were taught board room style with everyone seated around a table. We taught three things essential to changing TAB: how to relax, how to do daily drills to learn new behavior and how to have a monitor. The monitor could recognize TAB as it was occurring and substitute new behavior. I like to say that in conducting thousands of hours of these groups (composed almost entirely of men I never used up an entire box of Kleenex.

The group leaders would wait with great anticipation at each three-year interval when all 3,000 participants (1,500 controls and 1,500 treatment) would be reexamined to discover if their TAB scores had decreased. We would be given the results for our own groups, demonstrating whether the occurrence of TAB had been reduced in their daily lives. The only thing subjective was our prayers that the treatment had worked.

In the second, doing my “day job,” in my private practice, I continued to work largely in the world of the subjective and intuitive. My teachers, Bob and Mary had been masters of both. Their workshops drew people from all over the world. Their full schedules were a testimony to the appeal of the therapy they were teaching. It was not uncommon to have ﬁve or more nationalities represented in one of their twenty-eight-day residential workshops at their Western Institute for Group and Family Therapy.

There is little doubt that their work touched hundreds, thousands of lives. That is fact. That work appeared to have all the hallmarks of transformative psychotherapy. It was credible while also largely subjective. Excitement, joy, laughter and apparent resolution are infectious but hardly measurable. There was all of that in their work as well as great sincerity and total dedication.

My dissertation, Redecisions in Psychotherapy: A Study of the Effects of an Intensive Weekend Group Workshop was the ﬁrst formal attempt to measure the impact of their work. That study could not prove any measurable thinking and behavior changes among the subjects statistically. But they all reported having had a deeply meaningful and positive experience. All of them. By itself, that is remarkable.

OBJECTIVITY and SUBJECTIVITY

Watching my teachers work (especially for someone in his twenties) was an inspiration and a marvel. Participants would comment often in awe that they seemed to know them and their inner being within a short period of time. Mary particularly possessed an intuitive skill that occasionally bordered on the uncanny. She sometimes seemed more soothe sayer than therapist. Bob and Mary were unnaturally gifted. They worked on one another, a tandem team whose sum was greater than its parts.

But how does one teach that? How can the gifts possessed by one person be given to another? The answer: not very well.

The one area of objectivity was in their identiﬁcation of speciﬁc Injunctions. The term had been ﬁrst used by Berne but only as a passing observation. Bob and Mary picked up on the concept and began seeing repeated patterns and labelled them. They also had the gift of seeing what was there.

They were masterful in diagnosing injunctions using a mixture of historical information, clinical acumen and intuition.

Compare that approach to my ﬁrst interview with Dr. Friedman. I had come to Mount Zion Hospital in San Francisco in the hope of becoming one of his group counselors.

He was evaluating my ﬁtness for such a role. At the end of the hour, he asked me if I could describe to him the Type A behavior I had demonstrated during our time together.

I had avidly read both of his books, and I was eager to work with a man whose work I had admired for years. I could not adequately answer his question. I assented when he asked me for permission to share with me the Type A behavior he had observed during our interview.

He shared with me objectively, though not unkindly, his observations. I immediately recognized with great chagrin his accuracy in describing my behavior. He knew the symptoms of TAB when he saw them. From those he made his diagnosis. He did not intuit that I had been time urgent or had demonstrated ﬂashes of free-ﬂoating hostility. He described my exact and largely unconscious behaviors that revealed the presence of both.

Berne and Friedman differed in another important way. Wanting a more efficient therapy than lengthy psychoanalytic work, Berne encouraged his trainees to think about “how to cure the patient in one session.”

The Gouldings were enthusiastic adherents of this concept constructing an approach they called “Redecision therapy.” They expressed great consternation with therapists who would see people for years only to announce to them that they “were making good progress.” In their thinking and in their work, they revealed a belief that people could experience rapid transformative change.

They believed people could change the early decisions they had made in childhood in response to the Injunctions. They posited that such a new decision, a redecision made in the context of the historical origins of the early injunction would allow the person to take a new responsibility and be able to practice a new autonomy free from the inﬂuence of the injunction. It was a huge expectation.

Friedman’s approach could not have been more different. He would encourage the group leaders to remind our charges that changing their TAB would be one of the most difficult tasks of their lives. He did not say this to be discouraging but to give heart to anyone diligently seeking to behave more like someone characterized by Type B behavior (that is, lacking both time urgency and free-ﬂoating hostility) only to ﬁnd their TAB shattering those ambitions and returning in full force, if not full fury.

Berne did not live long enough to fully reap all the rewards of his work. I believe he would be staggered to know there is an important training institute in England named for him. Of course he was not without detractors who scoffed at his concepts.

In that realm he and Friedman were the same. Many in the medical community did not take kindly to this eminent scientist advocating for a “talking cure” to resolve a medical diagnosis. That skepticism remained despite his objective data and rigorous research that proved his thesis and the effectiveness of his treatment.*

* (For more than a decade the group leaders met once a month for ongoing training from Dr. Friedman and primarily Dr. Virginia Price. It was not uncommon for members of the faculty to bring the latest reports they had read on the viability of the TAB diagnosis and the success of its treatment. These reports were almost without fail negative critiques. It led Dr. Friedman to comment wryly on one occasion, “When we (TAB) are mentioned, we are never agreed with. And when we are agreed with, we are never mentioned.” Given the rigorous nature of he research and the unequivocal results, I asked him once when it took to have your own scientiﬁc discoveries accepted. To this he responded (consciously or unwittingly quoting a similar thought by Blaise Pascal), “You outlive your enemies.” )

On the other hand, the Gouldings received remarkable amounts of positive feedback, both in the fact of people traveling thousands of miles to train with them and their being invited to the four corners of the earth to put on training. People were eager to learn their fresh and energetic approach to psychotherapy.

And they received large amounts of anecdotal information as people would recount to them the positive impact they experienced from their work. Even today so many years after their institute formally closed with Bob’s death in 1992, it is not uncommon for me to encounter people who trained with them in the 1970’s and 1980’s who share enthusiastic and positive recollections of the time spent with them.

I certainly do. I cherish the memory of hundreds of hours spent with them, both watching and working with them. It is not uncommon for me to say to trainees today, “I wish I could take you back in time so you could experience their presence and the excitement they created.”

I also remember that Mary would be ever so slightly chaffed with me because I was constantly going outside of their system looking for other approaches that brought about change.

My own clinical experience began to reveal to me that the rapid transformation that they adamantly believed was possible did not exist in the world of “normal” people, all those who do not spend every waking moment of their lives consumed with thinking about psychotherapy.

In this context it is important to understand that the people who came to train with the Gouldings and to experience their approach to therapy were steeped in psychological yearning and had experienced long histories of their own personal therapy.

And most of those people, though certainly not all possessed an invaluable tool in life: a fully functioning and available prefrontal cortex. Most were free of any debilitating mental illness. Many were able to make rapid and dramatic change. That had more to do with the population than the techniques. There is an old saying, “The only place on earth you can become an overnight success is on Broadway.” Followed by a long pause, “After years of hard work.”

As I began to question the utility of the technical approach taught by the Gouldings, I had a growing belief that their most important contribution was the concept of identiﬁable injunctions, even if I no longer believed they could be quickly, even easily resolved or “ﬁnished” in Bob’s words.

A question began to appear for me coincident to a new training group I was asked to lead once a month by a remarkable woman and friend, Nina Miller. Once formed, it met every month in Nina’s home for the next eleven years.

I presented to them my thinking about the importance of the concept of Injunctions. I had felt disappointment when the Gouldings published their seminal book, Changing Lives Through Redecision Therapy in 1979. They described ﬁfteen injunctions in three spare pages, a brief paragraph for each. For me that was sparse especially considering I had come to the belief that this was their most important contribution.

Somewhere in our ﬁrst year together I put a proposition before the group: If the Injunctive Messages (as I came to call injunctions) truly exist there should be an accurate way to diagnose each one. There should be differentiation between the effects of each and have a recognizable “footprint.” And there should be recognizable changes in thinking and behaving as each one is resolved.

Resolved is a big word. As mentioned, my teachers thought they could be resolved by an act of permanent extinguishment. We found resolution to be a process, a journey. The ﬁrst and most important part of that journey is the accurate diagnosis of the most empowered Injunctive Messages in one’s life. A person cannot change what he or she does not know about. We cannot change without ﬁnding the correct path, usually by letting someone more knowledgeable guide us.

MELDING THE OBJECTIVE WITH THE SUBJECTIVE

In the development of the charts over the past thirty-ﬁve years one can recognize the melding of TA and TAB. They are a mixture of the subjective and the objective. Objectively, we look for the presence of what we call Coping Behaviors as the key diagnostic indicator for the presence of the Injunctive Message. The Resolving Activities are speciﬁc assignments of new behaviors and thoughts to practice forming new habits. To a trained observer the Coping Behaviors are obvious, much like Dr. Friedman having no problem in recognizing my TAB.

Subjectively, we did our creative best to capture the thinking of a person’s Despairing Decisions and their Deﬁant Decisions in response to each Injunctive Message. We spent long hours discussing the Coping Behaviors that came from repeated use of the Deﬁant Decisions.

We found it necessary to expand the list of identiﬁed injunctions from ﬁfteen to twenty-ﬁve. This came through the back door. We kept identifying distinctive Coping Behaviors for which there was no corresponding injunction to attach it to. Following this process we then found ourselves at sea with so many injunctions (now called Injunctive Messages), twenty-ﬁve of them. This led to the categorizing them into ﬁve areas of inﬂuence on: Survival. Attachment, Identity, Competence and Security.

When one goes to the right side of the charts you encounter the column headed, “The Redecision” followed by the words below, “Is accepting this unknown and unsuspected truth.” The twenty-ﬁve statements in that column meet the criteria for being true. One could honestly argue that there might be an even more powerful truth that could be posited to counter a particular Injunctive Message.

The truths presented in those spaces are profound and simple. They are referred to as “unknown and unsuspected” because they don’t exist in the presence of an Injunctive Message. To someone who was raised without full exposure to an Injunctive Message, the truths are self-evident and not surprising. “Of course there are lots of good people I can trust.”

Remember, the power of the Injunctive Message is due to it being a “Believable falsehood.” That is objective. There is no truth in any message to a developing human being that he or she should not be alive, should not have loving attachment, should not treasure their unique identity, should never feel competent or have no means by which to feel and enjoy being alive, to feel secure.

I hold in reverence the courageous effort put forth by my teachers to create a methodology to help people face their resistance to change and to empower them to break through the impasse between life as it had been experienced and the life they yearned for. They did propose a powerful formula to break through those impasses. And they asked too much from it. It could not deliver the speed of transformation they sought. Their concepts contain genius and promise; you just cannot blow up an impasse in one day and expect original behaviors to ﬂow from that one action.

To demonstrate the power of the Impasse there is a space between the left side and the right side of the charts. This represents the two states of existence presented in them. It also demonstrates the gulf between the two. It would truly be a lovely world if one could look at the charts and decide to live on the right side instead of the left. If only.

On the left there is a recycling of behavior that occurs when a person perceives the stimulation of an Injunctive Message. Having no way to discern what is happening, the person feels the despairing decision (that feels like truth) and counters it by using the Deﬁant Decision. This quickly, even instantly morphs into the use of the Coping Behavior and its familiar comfort.

On the right is a universe that is happily dominated by the integration of the unknown and unsuspected truths. New habits of thought and behavior have begun to replace the Coping Behaviors in moments of stress. This has been assisted by the determined use of the Resolving Activities.

Finally, there is a column on the far right, “A New Parental Voice that is Protective.” This new voice is primarily protective by helping the person not believe the falsehoods contained in the Injunctive Messages. This column contains very subjective phrases. The goal was for them to meet the criteria of being loving, powerful (agency) and anchored by common sense.

Inﬂuenced by Dr. Friedman’s belief that change is possible, if gradual and difficult, the even numbered pages were created. Those pages present a way to track a person’s journey from the left side to the right side. That journey is characterized by moving from a life characterized by struggle (with the Injunctive Message) and misery (believing the Despairing Decision to be true) to one characterized by acceptance of life as it is (full of both joy and suffering) and contentment, the ability to be happy during ordinary time and conﬁdent of soothing during difficult time.

The importance of the even numbered pages may not be as evident as the material contained on the odd numbered pages. The central concept for the even pages is that of movement. A person can track their movement from the left to the right. The movement is from one’s destructive relationship with the Injunctive messages to that of healing.

It is signiﬁcant that Dr. Friedman discovered that when a person reduced the frequency of TAB in their lives it provided protection from coronary vascular disease. That is when a person moved the set point of their initial TAB score to a set point with less TAB, they had moved in a direction from Type A toward behaving more like a Type B.

Life is about direction. In a revealing conversation with Dr. Steere not long after I began to study with him, I said with some amount of pride that I must have a very strong stomach. He asked me why. I told him that I had experienced a constant pain in my stomach for years but had never had any medical problems from it, such as an ulcer. I think I expected him to marvel at the virtue of my strong gut. Instead, he said, “Keep at it. You’ll get one.”

Keep going in a certain direction and one will arrive there. It is the same with smoking. One can smoke a remarkable quantity of cigarettes without visible damage. We know that if someone keeps at it there will be permanent and obvious lung damage. We also know that when one stops smoking, the healing effects are immediate, if subtle even in the ﬁrst twenty-four hours. Continue in that new direction and the lungs begin to renew themselves.

It is the same with movement on the graphs on the even pages. To traverse from the left side to the right side, integrating the Unsuspected Truth on the way, one must be able to name the ailment, that is, the Injunctive Message. As stated earlier, a person cannot change what he or she does not know about. That person must also be able to recognize the array of thoughts and feelings attendant to each one.

This is what Dr. Friedman did for me in our ﬁrst interview. He informed me of the TAB he had seen right in front of him in our interview. He identiﬁed it, called it by name and described for me a “worthy opponent,” one I could learn to recognize in real time and work to overcome with support and information.

Because Dr. Friedman’s work was based in objectivity, the lifeblood of the medical world he developed an instrument to show the presence of a person’s TAB as quantiﬁed by a numerical score. That score, a combination of the person’s score for Time Urgency and for Free Floating Hostility was called the person’s “set point.” The goal of treatment was to reduce that score. That measured the reduction in the use of TAB. Protection from future illness derived from the changing set point as a person’s score lowered.

These are the goals of the charts, ﬁrst to arm the practitioner with the tools to accurately diagnose each Injunctive Message. Secondly to be able to relate this information to the client and to have the conﬁdence to confront the Coping Behaviors as they occur.

You will remember Dr. Friedman asked for my permission, and only then did he inform me of the behaviors I had demonstrated. In doing so he provided me with an accurate medical diagnosis (he was a cardiologist, not a psychotherapist). I immediately accepted his diagnosis and the treatment for it.

In the same way we don’t ask a patient if they think they are suffering from the presence of an unresolved Injunctive Message. We listen to them; we observe them as they relate the reason for seeking our help.

As we listen and observe we can hear the words that convey despair even if attended by a smile or a laugh. We see and hear the transition to the Deﬁant Decision, the tone of the voice, the set of the jaw, the quality of “I’ll show you.”

From our questions about their lives and the conditions of their upbringing we discern the repeated patterns of behavior when facing stress, be it great or small: the Coping Behaviors for a particular Injunctive Message.

In our manner and our information, we invite the person to imagine there is a better life to live, one less miserable and less characterized by continual struggle. Most people imagine their struggles to be with forces external to themselves: their spouse, their parental ﬁgures, their superiors, etc.

It is a revelation, not always appreciated that their struggles are now within themselves. The struggle can often track back to the original source of the Injunctive Message. There might have been a parental ﬁgure who may have been guilty of harmful behavior, even cruelty. History is history and what happened to us happened.

However, the struggle today and its corresponding misery are not rooted so much in animosity toward those parental ﬁgures. It might feel as if it is. Rather, they come from the simple fact that the person believed the falsehoods contained in the Injunctive Messages. What choice did he or she have if no one was protecting them from the Injunctive Messages? The struggle comes from seeking to prove that belief wrong while inwardly and with dread believing it.

It is a good news, bad news situation. The bad news is that the struggle is internal and not subject to someone, perhaps long dead changing their message or their words. They can’t. The good news is that the struggle is internal, therefore we can resolve it by allowing ourselves to be led into a new reality based on replacing the false beliefs with the unsuspected truths contained under the column entitled, “Redecision.”

The purpose of the accurate diagnosis of an Injunctive Message is to offer the opportunity to resolve it as opposed to ﬁghting with it throughout one’s life. It is an invitation to migrate to the right side of the charts. After all, the man who diagnosed my TAB so succinctly, conﬁdently and accurately evinced none of his previous TAB during our interview. That had taken years of effort on his part.

At one point in the interview he did something I noticed but did not understand. During my fuselage of words as I spoke with great rapidity, he learned back in his chair, closed his eyes and placed his right hand against his cheek. I knew he wasn’t being rude, but neither did I pause and ask him what he was doing. Years later, I realized he was relaxing himself so he would not get caught up in my time urgency and respond with his own TAB in response. You see, nothing attracts our TAB like that of someone else. He had not always had that capacity.

His nickname as an eager and aggressive young intern had been “Cannonball!” Well, Cannonball was not in the room on that afternoon in late November of 1989. He had been replaced by a man who demonstrated interest, kindness, patience and a keen curiosity. The invitation was to learn what he had learned that allowed him to manifest such contentment and acceptance of reality.

I had read both of Dr. Friedman’s books. I knew he was describing me. I was not one of many people who announced upon reading his book, “I think I’m more Type B than Type A. I think my spouse should read it though.” That is like saying I think I am just a little bit pregnant. I recognized I had TAB. I did not know how to recognize its presence in real time, what the markers for it were. Nor did I have a way to learn alternative thoughts and behaviors to replace it, again in real time.

The charts propose to be a foundation of both, as diagnostic guide to help people learn what is outside their consciousness, their “blind side.” It needs to not be invisible to us, the practitioner. We must see and hear the Despairing Decisions, the Deﬁant Decisions and the all-important Coping Behaviors. And we need to serve as a model for living in different reality, doing our best to live from the right side of the charts.

In this way we are inviting people to cross the impasse (“we can help you”) and join us on the right side. As I often say, a person can have any number of legitimate arguments with the charts. Fair enough. I disagree with them frequently and modify them when I feel I have discovered what seems to be more accurate or powerful wording. But I believe that most everyone agrees with the proposition that it is better to live from the right side of the charts than from the left. It is better to live a life that is characterized by Acceptance and Contentment than Struggle and Misery.

There were an important similarities and disparities between the work of both men. When Games People Play became popular it was not uncommon for people to take it upon themselves and inform someone else, “You are playing a game with me.” In a similar manner, after Treating Type A Behavior and Your Heart came out it was almost a parlor game trying to determine if someone else was a Type A or a Type B.

The error with both pastimes is that these are serious and diagnosable conditions. They were not intended to be used as a new way to label and criticize other people. Indeed, both are predictors of possible serious outcomes; the negative payoffs from games that can damage intimacy and even health. There is the real possibility of coronary artery disease after years of unmonitored TAB, not to mention damage to personality and relationships.

This trivializes the discoveries of both men. To his credit, by the time I arrived on the scene, Dr. Friedman had created a severe guideline. We were to tell our participants they were not to use their newfound knowledge on their friends or family members. They were taught to apply the information to themselves and to correct their own behavior.

They were coached to never say, “You have TAB,” any more than someone should say to someone else, “You are playing a game with me.” They were told not to do this because it was just a more sophisticated form of their TAB, trying to give “helpful advice” or to tell someone they had a serious diagnosis.

Both my wife and I are therapists. It is not uncommon for us to share information we have gleaned from other sources. I had been strangely quiet the ﬁrst two years I was training with the Meyer Friedman Institute. One evening we were cleaning up after dinner. My wife turned to me and said, “Alright, let’s get this over with. You must be bursting. Am I a Type A or not?” Having been prepared for just this sort of question, I looked at her and said, “I have no idea. I have been working so hard to modify my own TAB that I have not had time to consider whether you are afflicted also,” or words to that effect.

She looked at me in mild disbelief. I was always eager to share my new learnings hoping she could “improve” with the knowledge. Then in the next moment she realized I was sincere. I had been busy building my own monitor to help me correct my own TAB, to protect her and my children from it, not preoccupied with applying the material to her. There are moments in a marriage. This was one of them.

On another occasion my wife shocked me slightly when she said, “I think Dr. Friedman has saved our marriage” It’s not that we had been in danger of divorce and had been pulled back from the brink of destruction. She was telling me that my efforts to reduce my TAB had removed a kind of sandpaper from our relationship. By learning to monitor and alter my TAB I had removed that unspoken obligation from her, that is trying to be my monitor.

On one occasion I summoned my courage and asked her if I had changed in a discernable way since beginning my work at the Institute. Without hesitation she said yes. “How?” I ventured to ask. “Two ways” was again her immediate response. “And they are?” “First,” she said, “I can talk to you now.” I knew what she meant. We had been chatterboxes since we met. She was saying she did not have to live in fear if she somehow misspoke while giving me feedback.

Still feeling a bit cautious, I asked, “And the second way?” “If you get into your old stuff,” she said, “all I have to say one word, and you quit immediately.” Then she added, “And that is wonderful.”

THE ANATOMY OF AN ICEBERG: TOP AND BOTTOM

In that ﬁrst interview with Dr. Friedman, he had also said to me that the participants in any future groups I would conduct for the Institute would not abide a hypocrite. I could not be asking them to modify their behavior without having modiﬁed my own. The comments above by my wife were an authentic testimony the progress I had made. But I had an additional ally in that change process.

It is important to recall that Dr. Friedman was a cardiologist, just as it is important to recall that Dr. Berne was a psychiatrist. Friedman saw a medical problem, coronary artery disease that was wreaking havoc among his patients. He set out to ﬁnd its cause and the treatment of for it.

He found out that TAB was the cause behind coronary heart disease. And he developed a treatment for it. He did not seek to ﬁnd the cause behind the development of TAB other than speculation about the lack of meaningful love from mother for men and the same lack from father in women. He never sought validation for those views.

His treatment was straightforward. Teach people to recognize their TAB while it is occurring and cease from using it by developing a strong monitor. Learn how to relax. Help the change process through regular group meetings to strengthen the monitor and teach the skills necessary for dealing with stress without resorting to TAB. And all the participants were given drills * to perform each day. These were simple, but powerful assignments that changed habits over time. And the drills were not intuitive for someone with TAB, such as ﬁnding a long line and stand it or linger at the table after a meal. For those who worked at it diligently, it worked.

It is common knowledge that when one sees an iceberg there is only ten percent of its mass visible. Ninety percent of that mass is under the surface of the water. The treatment for TAB is not a psychotherapy. In this imagery it focuses on the tip of the iceberg, that is the part that is clearly visible. It is a top-down approach with the hope that as behavior permanently changes then there will be a concomitant and deeper change within the person.

Berne’s approach was rooted in his psychoanalytic training where in this image the approach is to go as deeply into the base of the iceberg as possible with the hope that transformation at that level will translate into visible changed behavior and other indicators of wellness.

Berne’s* view and his emphasis on cure undergirded the Gouldings approach. Go as deep as possible in the shortest amount of time and look for an opportunity to restructure the damage of an earlier belief with a redecision. The stated goal and expectation of that approach was new behavior patterns would emerge that were healthy instead of those that were self-destructive.

*(As I have written this article that I have a repeated feeling of regret. As part of our friendship Dr. Freidman and I spent dozens of evenings over good meals with equally good wine. In those hundreds or hours, our conversation often veered into his insights about many of the well-known people or our time including past presidents (Truman, Ford and Carter whom he interviewed) and local luminaries. He was not overly judgmental or critical, just deeply insightful. He had been social friends with Herb Caen the famous gossip columnist for the San Francisco Chronicle. I asked once what he had been like. “A failed writer came the surprising reply.” “Why?” I asked, as he had been admired in his field. “Because he was never able to become a best-selling novelist, short of that he considered himself a failure.” In all our hours together, it never occurred to me to ask him about Dr. Berne whom he would most certainly have known about and perhaps known personally. I can only imagine what piquant insights he would have shared. )

My additional ally in being able to repair my behavior in my marriage and, hopefully, in all my intimate relationships was the knowledge I possessed about the lower recesses of the iceberg. I immediately understood the “why” behind much of TAB. And I was comfortable working at that level. At the same time, I recognized how valuable it was to be educated about the “Blind side,” that portion of one’s behavior that has negative impact on us and the on others while being mostly outside of consciousness.

THE DRIVING DRILL

In Chapter Sixteen of Games People Play, Berne restates his belief that the goal of all psychotherapy is the attainment of autonomy. In that chapter of the same name, he goes on to say, “The attainment of autonomy is manifested by the release or recovery of three capacities: awareness spontaneity and intimacy.”

For Friedman the goal of the treatment he designed was straight forward: to teach people afflicted with TAB to learn to behave increasingly like Type B’s, completely free of both time urgency and of free-ﬂoating hostility. Interestingly focused on how one drives an automobile as a key diagnostic indicator. They each emphasized that how one drove an automobile reﬂected how that person lived their lives.

In describing what he meant by awareness, Berne said, “Awareness requires living in the here and now and not in the elsewhere, the past or the future.” Friedman emphasized that the key cause for time urgency is the constant striving for a future where enough accomplishments have been attained and enough numbers collected to feel totally secure, a fantasy he called, “becoming superman,” an imaginary state where one’s self esteem is inviolate.

Berne describes four types of drivers. The most serious case is the person who drives with a preoccupation with being on time. He is the furthest from the goal of autonomy, Games People Play P. 179

While he is driving, he is almost completely lacking in autonomy, and as a human being he is in essence more dead than alive.” To this he adds this comment which could have come directly from Friedman even though this was more than a decade before he published his groundbreaking book, “It is quite possible that this is the most favorable condition for the development of hypertension or coronary disease.”

Berne then described that rare driver who possesses autonomy,

The fourth case is the person who is aware, and who will not hurry because he is living in the present moment with the environment which is here: the sky and the trees as well as the feeling of motion. To hurry is to neglect that environment and to be conscious only of something that is still out of sight down the road, or of mere obstacles or solely of oneself. P. 180

Just as Berne wished to help people escape the tyranny of their scripts, so Friedman wished to help people to be free from the instant, automatic and compulsive TAB. That is, both men wished for people to have choice about how to think and how to behave. To this end I added this phrase at the bottom of each drill card I gave to my group participants each month, “The process of transforming Type A Behavior is simply the creation of choice in place of our ancient and instant AIAI (Anger, Irritation, Aggravation, Impatience) reactions (McNeel).”

To this end, Friedman and his colleagues designed what he called, “The Driving Drill.” This was based on the assumption that if you could teach a person how to drive like a Type B rather than a Type A, it would be instructive in two important ways: the person would discover to their surprise that it is possible to change even the most ingrained behavior and secondly, that disaster (or lateness) did not occur following those changes. They still arrived at their desired locations in a timely manner and without exhaustion to prove their sincerity.

Here is a description of the driving drill. On the ﬁfth meeting in the ﬁrst year, we told our group members that they were going to learn how to drive like Type B’s and we would concentrate on that in the weeks to come.

They were to cease all forms of TAB while driving. That meant they were not to:

1. Honk in impatience. (only for the sake of safety).

2. Follow closely on the bumper of the person in front of them.

3. Intentionally slow down in front of another driver who was on their bumper to get them to hurry or move out of the way.

4. Use any angry gestures such as giving another driver the ﬁnger.

5. Use profanity toward another driver or pedestrians.

6. Use the inner most lane of the highway, the “struggle lane,” where people were most likely to be competing.

7. Weave in and out of traffic to gain time advantage.

8. To hurry up and go through a yellow signal they could easily and most likely stop for.

9. Go with the ﬂow of traffic. *

10. Commit any actions that expressed either time urgency or free-ﬂoating hostility.

* (I was conducting my ﬁrst two groups for the Institute when Dr. Friedman asked me how it was going. “Great,” I said. All the men in my groups are driving at the speed limit.” In return he said, “That is your TAB. The driving drill is not about getting people to adhere to a number, but to ﬂow with the traffic free of time urgency.” “Oh,” I said. He was right of course.)

This proposed compendium of behavior changes was often met with groans and laughs of disbelief. Did the teachers of this madness not live in the real world, and did they not understand how some of these changes might put them in danger? We nodded knowingly.

We instructed them to begin driving in the new way immediately. To help them in the process of such great change we would invite each person to give a report on their driving in subsequent sessions.

Here were the ground rules of the report:

1. Each person was to report on any infractions committed during the past week as a set of dice was passed around the room.

2. If the person had committed even one TAB act while driving, then he or she would have to roll the dice.

3. They would then tabulate the combined score of the two dice.

4. Using that total we would count around the room until landing on the person receiving the last number.

5. That person would then have to pay a ﬁne of $5 to the common kitty on behalf on the person who had committed the infraction.

6. If even one person committed an infraction, then everyone was required to listen to the “Driver Tape.” *

* (The audio tape that we placed was composed of three pieces. The ﬁrst segment is an excerpt of Dr. Friedman interviewing a man who is recovering from a coronary. One can hear the doctor coaxing the man to consider that his TAB was connected to his coronary heart disease. In no uncertain and argumentative terms, he rejects the thesis, constantly interrupting and talking over the doctor. His voice is harsh. The tape, lasting a bit over two minutes is unpleasant to listen because of his aggressive attitude. As it concludes, the man strongly expresses his belief that he is very successful due to his TAB. The second segment is also an interview with a man who exhibits Type B behavior. He describes a stimulus very similar to the one in the ﬁrst segment, an incident where someone was rude to him. Instead of becoming riled up, he laughs at the memory of the situation recalling the humor he saw as it was taking place. His voice tone throughout is pleasant to hear. The third segment is a brief recording of piano music by George Winston, a very beautiful and soothing piece. As this last piece is played, we would say to everyone that this is how we want them to experience the time they spend driving, using their automobiles as a place of peacefulness and sanctuary.)

As a sad note we would also inform everyone that this disagreeable sounding man had died of a second coronary following Dr. Friedman’s plea with him to join the counseling to correct his rampant TAB. On another revealing note one of my participants had known the abrasive sounding man. He said that in person he was pleasant and gracious unless aroused which caused his affliction to become manifest.

To everyone’s astonishment, and despite their howls of disbelief and disgruntlements in the beginning, their driving changed dramatically in the next ten to twelve weeks. * The ﬁne was much more effective when paid by someone else. Otherwise, lots of the men particularly would have swaggered in with their own ﬁve dollars in hand and paid gladly. Even though the sum was small, it was another thing to see someone pay in their stead. This was instructive to the fact that TAB not only harmed them but also others. The same thinking applied to the rule that the entire group had to “suer” through listening to the tape if only one person fell short.

* (This exercise was one that was deeply rewarding and great fun. For the most part it was received with good cheer and acceptance. In the hundreds of people who modiﬁed their driving in this way, one person sticks out in my memory, a top executive in a Fortune 500 company. She took great exception to the drill insisting it was necessary for her to drive the ﬁfty miles to her workplace at ninety miles per hour insisting angrily that it was not time urgency. She also refused to let anyone else pay her ﬁne. Sadly, and not surprisingly she withdrew herself from the treatment.)

I will add here that the reporting and rolling the dice was often accompanied by gales of laughter and equally heartfelt apologies to the people paying in their stead. The fees accumulated were generally given to charity by the group or used as a down payment for everyone to go to dinner.

The learning was profound and became a lasting lesson that it was possible to replace a former habit with another. They were reminded of this when facing the challenge of changing other behavior patterns. This was a victory all could recall and use as reassurance that change is possible. It was also a life lesson as no one experienced less success following these changes of behavior nor did they lose any respect, except for a spouse who was also afflicted with TAB who now showed irritation with the lack of time urgency on the part of the driver.

THE “TWENTY-FOUR-HOUR PILL”

Dr. Friedman posited an interesting idea during one of our faculty meetings. He said if he could design a pill that would have no side effects whatsoever that a person could take and then have a twenty-four period in their lives where they experienced no time urgency or free-ﬂoating hastily in their thinking or behavior, they would feel such extraordinary relief, they would not want to go back to their previous state of being.

In Dr. Berne’s language the same could be said if this same pill could deliver to someone the feelings of awareness, spontaneity and awareness, that is be freed from their script behaviors for twenty-four hours they also would not wish to voluntarily return to their previous manner of time structure and gaining recognition.

In my words, that pill would allow someone to live free of all Coping Behaviors for that twenty-four hours free live and solve life’s problems from the right-hand side of the charts. From that side for that period, the person would have no need to engage in self-harmful behavior, their energies could easily be directed toward those they love. And they would feel immense enjoyment of being only themselves and no one else. Life would be a constant learning from both victories and errors and there would be a sense of an underlying joy and conﬁdence instead of an underlying dread.

Pollyanna? Well, that pill doesn’t exist, but most of those people did learn to drive and feel a sense of well-being in their automobiles that had been foreign for them to even imagine.

POSTSCRIPT

I wrote the bulk of this paper over the weekend of November 8-10, 2024. My wife and I had made reservations months before for a stay at Deetjen’s Big Sur Inn in Big Sur, CA. It had been a cautionary move on our part just in case the presidential election went the wrong way. It did. To our shock and horror, the electorate had returned this deranged man to office.

Ordinarily, we would have been asleep moments after arriving at our retreat once the ﬁre had been set in the Franklin stove. Not for me. I felt profound despair and a quality of unreality as I tried to comprehend the tragedy that had just befallen my country. I felt outraged and helpless. The sweetness of a nap was far from me. I needed to do something. Anything.

By chance, I had brought with me a pad of paper and a pen, no computer. Lying propped up on the bed while Penny slept, I began to write this article. I experienced a torrent of words composing for the ﬁrst time by longhand in more than a decade, maybe two. I was astonished and gratiﬁed.

I could not change what had happened, but I could resist the darkness. I possess no means by which change the direction of history, but I do know love and I do know healing. I had considered writing this article for a few years about these two accomplished men. I had also assumed I would never get to it as there always seemed to be more pressing subjects.

So that is what I did that weekend. History has borne out my dread about this wicked man. He is far worse than feared, crueler than I ever imagined an American president could be. But my country is still here. If you read our history, you will know we have faced previous threats, grave threats to our democracy. There is a widespread and powerful push back taking place as I complete this article a year later.

Being Jewish, Dr. Friedman would have been the ﬁrst to say he was not well tutored in the New Testament of the Bible. But he commented on a conclusion he had reached. He said if one could distill the combined wisdom contained in the writings of psychologists and psychiatrists over the past two centuries into one ﬁfteen-minute speech, you would be left with the Sermon on the Mount, the Beatitudes emphasizing humility, forgiveness and love.

Neither Friedman nor Berne were blind to the danger of the sort of evil we see in the world today. In one of the last paragraphs in Treating Type A Behavior and your Heart, he wrote:

Let us not fool ourselves, moreover, about this simple but truly terrible fact: If Type A individuals ever succeed in taking over our society completely, it will scarcely be worth living in! We have resisted this conclusion for a long time, but it now seems to us unavoidable. The lovelessness at the center of the Type A’s spirit embitters all it touches. P. 290

In a similar vein, Berne speaks in What do You Say After You Say Hello? of “The Little Fascist” still present in each of us as an evolutionary artifact. “For Carnivorous anthropoids on the hunt, ruthlessness meant efficiency and greed was motivated by hunger.” He goes on to say that evolution has not selected these traits out of existence, so they present a current danger. In the unaware person they can be expressed as cruelty and exploitation.

Berne wrote:

These primitive strivings become interwoven with the injunctions, precepts, and permissions of the script, and form the basis for third-degree or “tissue” games that draw blood. He who pretends that these forces do not exist becomes their victim. (Italics added) P. 270

In their recognition of these inherent problems with humanity neither of them wrung their hands helplessly. They both stressed without active awareness there can be no change. No one ever changed a condition he denied having. A person locked in a destructive script cannot alter its course without being informed of the journey he is on unconsciously. And he must be supplied with alternative choices.

The person who reads the literature on TAB and says, “I don’t think that applies to me” while people around him stare back in wide-eyed disbelief cannot possibly have awareness of his current destructive behavior or its impact.

If one has no knowledge of the Injunctive Messages that are most powerful in their lives, they cannot know their Despairing Decisions that they have assimilated as fact. In this way they do not question the constant state of struggle in their lives as they seek through the Deﬁant Decisions to prove these falsehoods untrue.

The common thread running throughout is a lack of awareness and therefore a lack of choice. Berne wanted a methodology to free people from script behavior so they could attain Autonomy. He said it consisted of three things: awareness, spontaneity and intimacy.

Friedman sought a methodology whereby people could become aware of their TAB in real time and so be able to alter it into what he referred to at Type B Behavior (basically a complete absence of TAB). This could only come about through awareness of the TAB that others had seen and felt for years even if they could not name it.

I like to say that the goal of my ever-evolving charts is to create the choice of moving from the left side with its misery and struggle to the right side where life is characterized by contentment and acceptance.

In addition to awareness these pursuits require courage and determination to seek a greater wisdom, what William James called, “Common sense applied to behavior.”

To this end, Berne wrote:

It is better to be a martyr than to be a troglodyte, that is, a man who refuses to believe has ascended from an apelike creature because he hasn’t yet, but to know oneself is better than both. (Italics added) P. 270

In a similar vein, Friedman wrote:

Yet if a therapeutic process can be set into motion to help Type A’s ﬁnd serenity and affection in their own lives, we may cease worrying about what they will do to ours. We need not hate; such passions can be subdued provided serious steps are taken. (Italics added) P. 290

Inspired by these two men and all the wisdom and awareness shared throughout this article I am ﬁghting back. For me it not a slogan that I believe love is more powerful than hatred. I also believe that it is more useful to light a candle than to curse the darkness. In saying that I believe I speak for both these great men. I believe it was this conscious or unconscious belief that compelled them to their typewriters rather than to idleness. It is what compels me to mine.

This article is dedicated to the memory of
Eric Berne, M.D. Who enriched my life beyond measure though I never knew him
& Meyer Friedman, M.D. Whom I loved like a father and who treated me like a son, all while teaching me his wisdom.

And I wish to once again to recognize those people, both living and dead who made the creation of the charts possible, the members of the LA Training Group. Without them what you see is thin air and no charts. Nina Miller, Ruth Thurlow, Rebecca Dekker, Ellen Deker, Joe Shaub, Mark and Susan Faurot, Susan Tipton, Andy Whaling, Joyce Lauterback and Jo Anna Greenslade plus a few whose names have been lost. My gratitude to them is everlasting as is my love & And my “Phoboc” Family in Rome: Maria Luisa de Luca, Lucia Fruttero, Mara Mastromarino, and Carla de Nito Precious to me in a way for which I have no words.

For further reading connected to this article:

Games People Play, Eric Berne
What Do You Say After You Say Hello?, Eric Berne
Type A Behavior and Your Heart, Meyer Friedman and Ray Rosenmann
Treating Type A Behavior and Your Heart, Meyer Friedman and Diane Ulmer
Aspiring to Kindness: Transforming Male Type A Behavior, John McNeel (This book is contained in its entirety on my website: www.aspiringtokindness.com)

Dr. John R. McNeelMay 12, 2026Comment