When People Become "Service Users": What Transactional Analysis Reveals About How We See Ageing and Care

You may have seen from some of the Northside social media posts that I have parents who have become much older, and it seems to have happened in a fairly short space of time. Together with a couple of articles I've been reading recently, it's got me thinking about how we see ageing and what I might want to be my experience as I get older.

I've noticed that there is a particular kind of language that creeps in when we talk about older people or those who need "care." They become "service users," "care recipients," "cases." The terminology is meant to be neutral, sometimes even respectful. But it subtly positions the person as someone who is done to, rather than someone who does. The framing has already decided who has the expertise and who has the need and, importantly, who has the power in the relationship.

Although we might say that we see older people and those who need some form of support as full human beings with agency, preferences, and something to contribute, the systems and structures we operate within often tell a different story. I was interested in what this looks like through a Transactional Analysis lens.

The life position no one means to take

One of TA's most fundamental ideas is that we relate to others from one of four "life positions." The healthiest is "I'm OK, You're OK," a stance of mutual respect where both people are seen as having equal worth and capacity. But when someone is framed primarily through their needs, through what they cannot do or what they require, the relationship shifts. It moves toward "I'm OK, You're Not OK": I am the capable one, you are the one who needs help.

This can look like compassion. But the effect is the same: the other person's competence, their Adult capacity in TA terms, gets quietly set aside or not seen as important. What remains visible is their vulnerability, their dependency, their need for our intervention. In TA's language of ego states, the structure invites a Parent-Child transaction: one person positioned as the responsible authority, the other as the one who needs looking after.

This happens in care homes where decisions are made about residents rather than with them. It happens in GP surgeries where older patients are spoken to more slowly than the situation requires. It happens when people are praised for doing ordinary things, as though existing in public were an achievement. And it can happen in the therapy room, where a practitioner's assumptions about what a client is capable of exploring may limit the work before it begins.

Discounting what people can do

What is scary is that my children see me as in the "old" category. The one who can't write on my phone with two hands (because I have spent a lifetime touch typing). Or who might drive a little more cautiously (because I've been driving for years and make allowances for other people's driving). Completely discounting the fact that I run a business, a family and relationships reasonably competently.

In TA, this "discounting" means that we minimise or ignore some aspect of a person, a situation, or one's own capacity to respond. When we discount, we are not lying exactly. We are just not seeing the whole picture. Like my children acknowledging the bits they come across and not seeing the whole context of what I do or who I am.

With older people, the discount often lands on capacity. We discount their ability to make informed decisions. We discount their resilience. We discount their right to take risks, to be difficult, to say no. The result is a kind of benevolent flattening, where a complex person gets reduced to a set of needs that the system knows how to meet, because it's often easier to compartmentalise people than to work with the whole person.

The Rescuer dynamic

I was also thinking about the Drama Triangle*, where the system might say: these people are vulnerable, and it is your job to protect them. That framing, however well-intentioned, puts the carer or professional in Rescuer and the other person in Victim. When the person being "cared for" pushes back, asserts a preference, or refuses what is offered, the dynamic can flip: suddenly they are "difficult," "non-compliant," "resistant." In Drama Triangle terms, they have been repositioned as Persecutor, simply for exercising agency.

Therapists are not immune to this. Working with an older client who insists on a decision you consider unwise, or a disabled client who declines your carefully considered therapeutic direction, can activate the Rescuer in ways that feel like professional concern but function as control.

Cultural scripts

Cultural scripts have a part to play here too, don't they? The unconscious story we absorb about how their life is supposed to go, the narrative that shapes their choices without them quite realising it is called script in TA. Scripts are not only personal. They are cultural too.

Society writes scripts for older people: decline, withdrawal, irrelevance, invisibility. These scripts are powerful because they do not announce themselves. They simply shape what seems normal.

How often do we forget to consider what colourful stories and lives the people in front of us might have had? Where they have come from, the challenges and experiences that have shaped who they are?

I intend to fight the cultural script that says: at your age, there is nothing left to move toward. I want to continue doing new things, going to new places, meeting new people. And continue to bring colour and life and movement for as long as possible. And treat other people accordingly.

What about the therapy room?

Caring is not the issue. But the structures we work within, and the cultural assumptions we absorb without noticing, can reproduce exactly the patterns we would consciously reject.

What helps is the kind of reflective practice that makes the invisible visible. Clinical supervision can help with examining not just the content of their work with a client, but the relational dynamics underneath it:

Which ego state am I operating from?

Am I genuinely contracting with this person, or am I deciding what they need?

Is my concern for their welfare actually an expression of my own discomfort with their choices?

TA does not offer a way to fix society's relationship with ageing and disability. But it does offer a way to see it clearly, and to notice when we are participating in something we thought we had outgrown.

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If you're curious about the TA concepts in this post, the TA101 is a two-day introduction to Transactional Analysis and a good place to start.

Frequently Asked Questions

How does society position older people and disabled people?

Older people and disabled people are often positioned as "service users" or "care recipients," framing that defines them by their needs rather than their personhood. This can happen through institutional language, care structures, and cultural assumptions that emphasise vulnerability and dependency over agency and capacity. Transactional Analysis describes this as a shift from an "I'm OK, You're OK" stance to an "I'm OK, You're Not OK" position, where the person is seen primarily through what they lack.

What is discounting in Transactional Analysis?

Discounting is a TA concept that describes minimising or overlooking some aspect of reality, whether that is a person's capacity, the significance of a problem, or one's own ability to respond. In the context of ageing and disability, discounting often takes the form of underestimating what someone can do, decide, or contribute, leading to well-intentioned but limiting responses from professionals and carers.

What is the Drama Triangle and how does it relate to care?

The Drama Triangle, developed by Stephen Karpman, describes three relational roles: Rescuer, Victim, and Persecutor. In care settings, the system can position professionals as Rescuers and the people they support as Victims. When the person asserts their own preferences or pushes back, they may be unconsciously repositioned as a Persecutor (seen as "difficult" or "non-compliant"). Understanding this dynamic helps practitioners notice when they have moved from supporting someone to inadvertently controlling them.

How can therapists avoid reproducing these dynamics with older or disabled clients?

Reflective practice and clinical supervision are key. Practitioners can use TA concepts to examine which ego state they are operating from, whether they are genuinely contracting with the client or making assumptions about what the client needs, and whether their concern for a client's welfare might be functioning as a Rescuer dynamic. The goal is not to eliminate professional responsibility but to hold it alongside genuine respect for the client's autonomy and Adult capacity.

What are cultural scripts in TA?

In Transactional Analysis, scripts are the unconscious life stories people absorb about who they are and what their future holds. Cultural scripts extend this idea to the stories society tells about particular groups. For older people, the prevailing cultural script often centres on decline and withdrawal. For disabled people, it may centre on limitation or dependence. Recognising these scripts in therapeutic work means holding open the possibility that a client's sense of what is available to them may be shaped by cultural narratives as much as by personal experience.

*Stephen Karpman