Transactional Analysis in Spain: The Journey to Exist

Por José Manuel Martínez

Publicado en The Script, (Newsletter of the International Transactional Analysis Association) vol. 51 nº. 2. February 2021.

I am pleased to inform the TA community that on 23 November 2020, the Ministry of Health and the Ministry of Science and Innovation in Spain sent a jointly signed
letter informing us that, having reviewed and valued the information recently rovided by our Asociacción de Profesionales de Psicología Humanista y Análisis Transaccional (APPHAT) dated 27 September 2020, they are modifying the list of pseudotherapies in which transactional analysis had been included since 2019. This inclusion occurred because they found no publications in the scientific literature (randomized clinical trials or meta-analyses) published in Pubmed during the period 2012-2018 that guaranteed the clinical effectiveness and safety of transactional analysis.
The Spanish government had been developing actions since 2018 in the context of a “Plan for the Protection of Health from Pseudotherapies” by which they tried to protect the population from the undesirable effects of healing procedures that do not have a safety and efficacy assessment.

In the final months of 2018 and early 2019, the government commissioned epidemiologists from the Carlos III Institute and the Health Technology Assessment Agencies of Spain to make a judgment about the “scientificity” of a multitude of therapeutic techniques and methods.

In February 2019, the government published a progress report on the results obtained by the evaluation agencies. The result was that transactional analysis was classified as a “pseudotherapy” alongside methods such as Atlantis angels, harmonics, arolo tifar, ataraxia, aura soma, biocybernetics, breema, energy surgery, transformational coaching, systematic constellations, quartz crystas, chromopus, quartz bowls, Tibetan bowls, diafreotherapy, geochromotherapy, geotherapy, graphotherapy, colon hydrotherapy, Ericksonian hypnosis, homeosynthesis, iridology, lama-fera, babandi massage, Californian massage, chakra energy massage, metamorphic massage, Tibetan massage, anthroposophical medicine, and so on.

This list was systematically disseminated by the media (television, newspapers, magazines, weeklies, the government website, internet, etc.) with messages in different formats that communicated many prejudices, seriously violating the rights of patients and professionals. These notifications generated doubts in the former and discounted the training and professional experiences of the latter, damage that can hardly be repaired even if the relevant claims succeeded in the courts.

The unusual thing is that the government apparently wanted to “protect” the people from the adverse or even deleterious effects of these pseudotherapies but without a demand for such protection or concerns about these methods. In fact, the government sought to exclude these methods from public and private practice based on a few recent cases of patients who were harmed. Another unusual aspect was that, instead of limiting its action to the methods that had documented negative effects, the government extended the evaluation to a large range of methods and techniques, including psychotherapies such as
transactional analysis, integrative psychotherapy, gestalt, bioenergetics, and so on.

We also set up an APPHAT research team to search for studies of effectiveness, and sent a new report to the government. After analyzing the report and the new studies, transactional analysis was added to the list of potentially valuable techniques

In light of these developments, our national TA association, APPHAT, implemented several claims in front of the government and presented
110 controlled studies about the effectiveness of transactional analysis, of which 33 had a study design that was close to randomized controlled trials. However, they were not admitted because they were considered quasiexperimental studies.

In February 2020 we asked for help from the Spanish ombudsman and
requested information, support, and suggestions from several Spanish
European parliamentarians from the European Union Health Commission about European community standards that could protect our rights. We also sent information to the 17 health departments of the comunidades Autónomas in Spain and asked them for claim and support in front of the National Health Department.
We also asked for help from the European Association for Transactional Analysis (EATA), the International Transactional Analysis Association (ITAA), and the European Association for Psychotherapy (EAP). All three sent support letters that we presented as a part of our report.

We also set up an APPHAT research team to search for studies of effectiveness, and in September 2020 we sent a new report to the government. We were then told that, after analyzing the report and the new studies sent by APPHAT, transactional analysis would be added to the list of potentially valuable techniques for which both ministries have established a progressive evaluation process according to a methodological framework and a procedure established within the Spanish Network of Health Technology Agencies.

It appears that this evaluation will take into account the participation of the actors concerned both in the initial process of the evaluation process (in the development of the protocol defining the approach and scope of the evaluation) as well as after the evaluation has been carried out. Before completion, they will seek opinions and obtain additional information from these agents of interest through organizations or associations as well as representatives of other health organizations (scientific societies, professional colleges, etc.) and patient associations.

After 2 years of work and ongoing communication with the Spanish
Health Administration, we have managed to get TA removed from
the list of pseudotherapies, although the damage caused to the prestige of our professionals and the confusion created among patients now needs to be taken into account and repaired.

José M. Martínez Rodríguez, 
President of the Asociación de Profesionales de 
Psicología Humanista y Análisis Transaccional (APPHAT)                
can be reached at