An Exploration on Protocol and Disease in the Body

Published in the Transactional Analyst, Autumn 2024

I’ve become increasingly interested in understanding and discussing the Transactional Analysis term of ‘protocol’ coined by Eric Berne when developing his theory of understanding human behaviour.

I like to get to the root or core of a problem. I have a sense that when Berne was formulating his theory of protocol that he was looking at the foundations for the rest of his concept, despite leaving this area relatively unexplored. There is scarce mention of protocol in Berne’s writing and he develops the term more in some of his later work. Subsequent writers have developed the theory of protocol, mainly body psychotherapists, and discussed links with other modalities, but it is still under-represented in the TA literature. Surprising when protocol informs and underlies script and all subsequent transactions.

My curiosity on protocol developed after having a serious neck injury, a cervical disc prolapse with nerve compression, which lead to a period of incapacitation and rehabilitation. This alongside my background before working as a psychotherapist was a career as a medical doctor, identifying and diagnosis issues with the body and mind.

The injury happened when I rolled over in the middle of the night whilst camping and I felt something pull in my neck. My neck had ‘broken down’ or had ‘given way’ seemingly spontaneously with no obvious reason. Thinking more laterally I began to wonder if my body breaking down had a psychological message or not, or could this be an experience of something happening in me on a protocol level. The injury occurred at an emotionally challenging time for myself, after a prolonged period of isolation and feeling lonely. I look back at this time in my life as a time i was largely in a ‘state of exile’ and hiding from the world, partly enforced during Covid lockdowns and partly a way i knew how to manage myself after an intimate relationship ending. I started to ask the question, why did my neck give way? and wanted to see if TA theory could provide me with some answers. Could there be a link between protocol and disease in the body?

What is Protocol?

I was asked this question recently after i mentioned to a colleague that i was in the middle of writing this essay and found myself struggling to find the words to explain my understanding. Then i realised how emersed in the topic i had become as in essence its nature and character is difficult to formulate in language, words are a miss representation and over simplify its character.

A dictionary definition describes the word protocol to generally mean an official set of procedures for what actions to take in a certain situation. The word originates from the Greek word protokollon, ‘proto’ meaning first and ‘kollema’ meaning something bound or glued together. First records of the word from the 1500s in Latin show ‘a leaf or tag attached to a rolled papyrus manuscript and containing notes as to its contents.’ 1

Berne used the term protocol to describe ‘the original dramatic experiences on which script is derived.’2 ‘The life script starts off in childhood in a primitive form called a protocol. Here the other players are limited to parents and brothers and sisters; or an institution....they all play their roles rather rigidly because every family is an institution.’2

In Transactional Analysis in Psychotherapy, Berne writes that ‘there is no specific word in psychoanalysis for the original experiences from which transference reactions are derived.’ I think at the time Berne was suggesting that protocol is deeply unconscious and that the transferential domain may be a gateway to knowing more about protocol. ‘In script analysis, the household drama which is first played out to an unsatisfactory conclusion in the earliest years of life is called the protocol.’ 3

Berne initially links protocol, script and adaptation under the term ‘script’ as this may be most meaningful to patients. The child is originally programmed by his mother and this program forms the ‘original skeleton’ of his script. It becomes largely forgotten (unconscious) and is replaced by a more civilised version, the script proper. 3

What are the origins of protocol?

There is overlap and association between Intuition, primal image and protocol. Berne’s concept of protocol developed from an exploration of intuition, a sense of knowing from ones senses without having yet formulated language or reason, and primal image, a primitive imprint on the body by a significant others ‘mode of relating.’ I see an overlap between a primal judgement, an act of judgement based on the formation of an image which happens simultaneously, and intuition. Protocol encapsulates the former two, intuition being around decision making and reasoning and primal image being more a somatic impression left by the other.4, 5 ,6

Protocol is distinct and interwoven with script. Script is pre-conscious decision based actions made as a child as an adaptive or defensive way to best survive its environment, and is made available for knowing about through interpretation of ulterior communication and game like behaviour. Protocol is unconscious and felt or lived in the immediacy of ones body. Protocol is a sense of self and always within us, informing every thought, feeling or behaviour.6

Development after Berne

Subsequent psychotherapists have done much to advance understanding and scope of what protocol means in the context of therapeutic engagement and personal development after Berne’s ‘primitive’ nuggets of thinking around the idea.

Cornell and Landaiche discuss how ‘protocol is a latent level of somatic and relational organisation that precedes the formation of script and operates outside of conscious awareness... it is the literal embodiment of the repetitive, often affectively intense, patterns of relatedness preceding the infant’s capacity of ego function. Protocol precedes and underlies the subsequent narrative-based script... it is not a set of adaptive or defensive decisions like a script’6

They suggest Berne was describing an unconscious, fundamental relational experience that underlies many transferential experiences, be they expressed as impasses, enactments, parallel process, or projective identification. ‘Protocol is a kernel of nonverbal, somatic experience that may be touched or triggered in intimate relationships. The child ego state is deeply opened in therapeutic relationships evoking protocol, allowing transferential dynamics to be lived within.’6

Cornell links Bucci’s theory of the symbolic and subsymbolic to TA impasses. The subsymbolic resembles protocol in that it is deeply unconscious and proceeds the formations of symbolisation but contains affect, somatic sensation and sensorimotor patterns. The subsymbolic shapes, experientially and often unconsciously, explicit memory and the verbal symbolic and symbolic. Implicit memory is linked to the subsymbolic however not purely relational and contains somatic organisation that is intrapsychic and sensorimotoric. They write extensively in broadening and deepening the concept and understanding of protocol, in many ways highlighting the mysterious, intangible, unknown knowing quality it permeates.7

Steere suggests that what we encounter clinically as protocol is a sensorimotor-intuitive product of our early life experience with its own private symbolic schemes which defy simple verbal communication and comprehension. Movement is thought, since our earliest thinking is in sensorimotor schemes, the key to archaic thinking undergirding our life course is found in movement behaviour when we are in script. Protocol not only reveals the most primitive programs governing the script, it also points to those behaviours governing the script.8

Oates writes how protocol is a body-based level of experience at a ‘cellular’ level.9 I suggest protocol is the substrate of who we are, the building blocks, containing our genetic material and the influences the environment has on genotype up to an age when language and symbolism occurs, an age where communication develops in different ways other than our being. Like the period of moulding before cement sets or wax cools down. The raw material is there and it is extremely impressionable to moulding from a hand or container. Once set the skeleton or matrix is formed and this is the operating system for the rest of our life.

I understand protocol to be a persons way of being in their body in the world, and more than a way, it is literally their body being in the world and this developed as a baby through their experience of being with an (m)other and the environment.

Can protocols be changed and how?

Cornell and Landiache suggest that unlike script, protocol cannot be changed and redecided but instead lived within and new decisions can be made on what to do with this. ‘We can never diffuse their intensity, but we can open them to new experience and action. We can only alter how we behave as a consequence of our protocols’6

I understand protocol to be operating at a level 3 impasse, that which is a stuckness within the sense of self and way of being at a C0 level.10 The issues brought into treatment are anchored at a somatic, ‘tissue’ level and simply not affected in any enduring way by the traditional TA means of cognitive/interpretative interventions. Cornell presents a case where the client is ‘unhappy’ in their body and it is learned that this is known in the client at a protocol level. When impasse is rooted at the ‘tissue’ level, client and therapist must typically enter the suffering and live it together in order to experience an understanding in the mode in which the problem is being held and enacted. ‘When somatic/relational experience is at the level of protocol, there is no clear distinction between self and other, it is extremely hard to tell who is having what experience, to whom a feeling or fantasy belongs. The level of protocol occurs often at the periods of most intense personal growth, most intimate stages of psychotherapy, or of the deepening of our intimate relationships.’ 6, 7, 9

Oates believes that we are ‘stuck’ with our protocol for life. However a profound expansion in clients lives can be brought about through the ‘willingness of client and therapist to risk more of themselves in the therapeutic relationship’ and in this ‘open them up to new experience and action.’  Particularly when a persons becoming of themselves was unable to start due to a negating environment from entering into the world.9, 11

I think of my recent experiences at a 5rhythms dance class, an exploration of the self while moving to music. When the group is directed to engage in a dance with another person i quickly feel nervous and hesitant, my heart pounds and i have bodily sense of scare. When facing a partner I increasingly notice how I reflexively mirror and follow their routine, then at times i go to making my own movements and have come to notice that i may not be dancing connectedly with the other person at all. The space in-between being fused or disconnected, i feel shaky in my body, my heart races faster, my movements are hesitant, clunky and almost uncoordinated. This may be a new experience unfamiliar in my protocol. It is ‘under my skin’. Repeated classes and exposure to new experience like this may reduce my bodily response, an expansion of my movement and contact with another, however I’m still terrified each time I’m in this position. These reflections came after repeated experience of staying with this discomfort and after the events.

Steere brings attention to noticing how someone holds themselves in day to day life, motor movements, posture, and links these clue to injunctions, counter-injunctions and script decisions. Examples are presented to illustrate how making new sensorimotor experiences in therapy may give access to and change a persons protocol. ‘The best explanation for the phenomenon of protocol is that the child ego state preserves in particular psychomotor patterns an often repeated sequence of events from formative years.’8

Transformation seems to require that the therapist makes use of his or her embodied perceptions and operate with them as forms of action, psychotherapeutic work needs to extend beyond models of ego consciousness. Deaconu sees this as similar to what Bollas described as development of incarnated intelligence, the ability to inhabit another whilst remaining within yourself. Deaconu writes that to be a Bernian ‘thinking Martian’ required more than thinking if successful transformation is to be brought about, an embodied subsymbolic relational experience at a protocol level and using this with personal agency to be unique and potentially transformative in new ways of being with another.12 

Relational structures, created during the construction of protocol, become an important basis for the individuals subsequent relationships. Change comes through interpersonal emotional communication. Procedural unconscious responses are communicated through nonverbal signs; voice, breathing, sweating, facial expressions, visceral and muscular movements. Our protocol is formed through attachment and relationship and therefore a new experience of relationship can restructure ones protocol.13

I understand the literature post Berne to be questioning how we come to know more of protocol and work with it, with a difference in opinion on the ability to know of ones protocol, from a more possible knowing through movement, body language, posture and transferential dynamics to a less possible knowing due to its insidious ineffable quality and the potential to live with and within the possibility of coming to learn more from experiences. I believe our protocols can be known of and developed through engaging in deeply connected relational experiences in the ways highlighted, including through affective bodily engagement and movement, which requires commitment and the meaning will take time to evolve. Knowing more of the nature of our wonky ‘penny stack’ or our ‘skeleton’ could give us choices on where this best fits in the world or to even remould some of the troublesome kinks through new different healing experiences, however the core structure remains with us. 

Protocol and the body

Cells are the building blocks for the body and when they dysfunction we can see pathology. What if an initial experience is traumatic or non supportive for optimal growth and development. The environment places stress or strain on the person and changes occur at a cellular level. We known the impact trauma has on the body. The amygdala becomes hypersensitive and the ‘thinking’ cortex goes offline. Fight, flight or freeze responses are seen. Any event which appears similar to the original unsupported experience can trigger this cascade. It is common to talk of trauma in terms of an unhealed wound, either raw or covered in scar tissue, suggesting an injury to the body. A babies developing brain is shaped by its environment. Trauma is stored in implicit memory which is more accurate and never forgets, unlike explicit memory.14, 15, 16

Ciazzi suggests that traumatic experience is taken in by the body and can be reorganised through a relational approach paying attention to bodily experiences and transference.  Her article illustrates how victims of torture are impacted on a protocol level, the body is wounded, and unexplained symptoms can be the physical expression of deep psychological dynamics resulting from what happened to them.17 Is somatisation, a set of symptoms not explained by physical pathology, test or investigation results, an expression of someone’s protocol?

Mate makes many links between disease and a persons psychosocial makeup, the hidden stresses generated from early programming and how that may present as the body saying no, how deeply hidden unexpressed emotions may lead to pathology. Cancer as a lifelong unexpressed anger turned against the self, autoimmune disease as the immune system attacking the body due to a deep sense of not liking oneself. These ways of being are so deep and subtle they become a part of our real selves.18 Are they part of our protocol?

Going back to the wax and concrete symbolism, is an experience of enough heat or breaking and redistributing needed to reform a protocol. A fundamental restructuring needs to take place for an update on this. Heat or pressure, an intensification in a relationship or experience of an impasse, for it to break. Could it have been that the more isolated i became, i was camping alone in the Lake district on a bleak Autumn night, the more my 3rd degree impasse was lived within, the more my protocol was experienced, an increasing rigidity in my body and holding of myself together without little support, that my body broke. I found myself in an essential place of needing care and reconnected with my family, experiencing new ways of being cared for.

What is re enacted in life is a persons way of telling the story of what happened to them. What is re – expressed in the body is a persons way of showing or living or being what happened to them. I’m linking protocol with trauma, the traumatic imprints during our impressionable early days as a baby, this stays within the body and could form part of our protocol, which in turn over the course of decades starts to express itself through the body in the form of disease or pathology. We can access and understand more about protocol through living within and through the transferential domain in a therapeutic process from what happens both inside and outside the room, can we also know more about our protocol by what diseases present in the body?

References

1. https://www.dictionary.com/browse/protocol

2. Berne, E. (1972) What do you sat after you say hello?: The psychology of human destiny. New York: Grove Press.

3. Berne, E. (1961) Transactional analysis in psychotherapy: A systemic individual and social psychiatry. New York: Grove Press.

4. Berne, E. (1975) The structures and dynamics of organisations and groups. New York: Grove Press. (Original work published 1963)

5. Berne, E. (1977) Intuition and ego states: The origins of transactional analysis (P. McCormick, Ed.). San Francisco: TA Press.

6. Cornell, W. F & Landaiche, ӀII, N. M. (2006) Impasse and Intimacy: Applying Berne’s Concept of Script Protocol.  Transactional Analysis Journal, Volume 36, Number 3, 196-213.

7. Cornell, W. F. (2008) “My body is unhappy”: Somatic Foundations of Script and Script Protocol. Explorations in Transactional Analysis, The Meech Lake Papers. TA Press.

8. Steere, D. (1985) Protocol. Transactional Analysis Journal, Volume 15, Issue 4.

9. Oates, S. (2014) The Impact of Absence and the Ineffable Quality of Protocol. Transactional Analysis Journal, 44:4, 243-254.

10. Mellor, K. (1980) Impasses: A developmental and structural understanding. Transactional Analysis Journal. Volume 10. Number 3.

11. Oates, S (2012) Who Decides and What Can Be Changed?, Transactional Analysis Journal, Volume 42, Number 3, 176-182.

12. Deaconu, D (2020) The Therapist’s Agency as a Subsymbolic Working Tool in the Clinical Encounter: On the Phenomenology of Thinking Martian. Transactional Analysis Journal, Volume 50. Number 3, 193-206.  

13. Guglielmotti, R. F (2008) The Quality of the Therapeutic Relationship as a Factor in Helping to Change the Client's Protocol or Implicit Memory.  Transactional Analysis Journal, Volume 38. Number 2, 101-109,

14. Mate, G (2019) When the body says no: The cost of hidden stress. Vermillion.

15. Van de Kolk, B (2015) The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin.

16. Gerhardt, S (2014) Why love matters: How affection shapes a babies brain. Routledge.

17. Caizzi, C (2012) Embodied Trauma: Using the Subsymbolic Mode to Access and Change Script Protocol in Traumatized Adults, Transactional Analysis Journal, Volume 42, Number 3, 165-175.

18. Mate, G. (2022) The myth of Normal. Vermilion: Penguin Random House Group.