Psychotherapy is one of the main subjects in psychiatric education . Regarding on Accreditation Council for Graduate Medical Education (ACGME), some basic standard of psychotherapy must be mastered by psychiatrist including brief dynamic psychotherapy (BDT), cognitive behavioral therapy (CBT), psychodynamic analysis (PA), and supportive psychotherapy, as well as the combination of psychopharmacology and psychotherapy [1,2]. Based on competence standard guidelines, transactional analysis (TA) has not been included in the required competency for a psychiatrist, although the application of TA gives good result in many cases and shows the effectiveness of psychotherapy in coping with anxiety disorders and depression [3.4]. TA's application can also reduce symptoms of post-traumatic stress disorder  and also effective for co-morbid depression [6,7]. TA also has been found to be cost-effective when it is applied in patients with personality disorder and even in a non-psychiatric case such as multiplex alopecia areata, with the benefit of improving long-term medical condition [8,9].
Currently, the cases of emotional and behavioral problems are increasing in children and adolescents. One of the reasons is due to the parent-child relationship issues. A conductive kind environment and a good relationship between parents and child should be maintained, especially when the child has a genetic risk of mental disorder. This strategy will prevent the genetic factor to appear. Relationship problem in a family is not only influenced by parents-child relationship but also by parents' marital problems [10,11]. The benefit of applying TA in coping with relationship problem is its ability to change and transform patient personality by using daily sentence approach which is easy to be understood [12-14].
Although TA has been one of the subjects studied in medical faculty in University of Indonesia since 1975, it has never been taught in the form of training module. In fact, not all psychiatry educational centers in Indonesia teach TA-based psychotherapy. We study problems faced by psychiatrists and residents when they use TA book from Indonesian Psychiatry Collegiums. Therefore, we analyzed whether the current TA book requires an additional TA application module as a guide for TA psychotherapy. The result of this study would be a basis to develop and to improve TA application in formulating guideline module for parents-child relationship problem solving.
This cross-sectional descriptive study was conducted in 107 respondents by distributing a questionnaire about "Needs Analysis of Transactional Analysis Applications" to psychiatrists and residents in Indonesia, either directly or via email. The study subjects were taken from three national meetings related to psychiatry in Jogjakarta and Solo in 2014, and also from psychiatrists and residents at 7 psychiatry educational centers in Indonesia during the same period. The time limit for distributing and returning the questionnaire was 2 weeks. In order to remind the respondents about the time limit, the notification was delivered every 3 days by email or phone call. The subjects included in the study were those whose questionnaires completed within a predetermined time limit. Previously, a semi-structured questionnaire was performed, in order to achieve a wider response  by authors who were expert in this field. Questions in the questionnaire had undegone a pilot testing involving 12 residents for the face validity and 2 psychiatrists for the content validity. The outcomes of those validities were good. Of the 219 prospect respondents willing to be enrolled in the study, 107 subjects were selected randomly according to the calculation of sample size. The determination of sample was done by simple random sampling method  and a single sample size calculation to estimate the proportion of the population.
There were 107 subjects who completed their questionnaires. The study subjects' characteristics are presented in Table 1. Most of the subjects were females (65.5%) and many of them were over 35 years old. The mean age was 42 years old, with the youngest one aged 26 years old the oldest was 73 years old. The proportion of psychiatrists and residents was equivalent.
Almost all subjects admitted that they had already received TA education (75.7%). About 30% subjects had TA training. Most of subjects followed the TA training once in their career (81.3%). Nearly half of the total subjects used TA in managing the relationship problems. Almost all subjects know the basic types of psychotherapy; i.e., cognitive behavior therapy, brief psychodynamic, and transactional analysis. The reason in using TA for relationship problems was because TA has proven to be suitable and easy to apply. Subjects who did not use TA declared they did not know how to perform the application of TA. All subjects affirmed that they need some modules to perform TA. Strategies that can immediately improve the knowledge and skills of TA were primarily with training and mastering the contents of TA's module (shown in Table 2). The most common psychotherapy used as the strategy to deal with psychiatric disorders was CBT, followed by BDP, TA, supportive psychotherapy and others including marital therapy, solution focused therapy, logotherapy, hypnotherapy, reality therapy, psycho-religious, play therapy, Gestalt Therapy. In managing the relationship problems, the subjects largely used TA, followed by CBT, BP, supportive therapy, and others including marital therapy, solution focused therapy, logo therapy, hypnotherapy, reality therapy, psycho-religious, play therapy, gestalt, and mixed psychotherapy (Table 3).
In this study, only half of the total subjects used TA, although it can easily be applied in patients. Our study also demonstrated various types of psychotherapy used in Indonesia in managing psychiatry problem particularly in relationship (Table 3). This finding is supported by previous study which reported that there were various approaches in solving relationship problems such as supportive , marital [18,19] or couple therapies [20,21], as well as for general relation problems in the family. Psychotherapy approaches usually consist of family therapy , experiential family therapy , structural family therapy [24,25]. Therapy based on cognitive and behavior are also used to address problems in family relationships, including couple therapy [26-31], solution focused brief therapy , narrative therapy  and family problem solving  Thus, standardization on the use of psychotherapy for treating specific cases is needed in order to gain the most appropriate and feasible form to achieve optimal results.
This study was also in line with a previous study by McQuaid which showed that TA training to meet psychotherapy competency frequently used varied training methods and there was no uniformity . Consequently, the need of standardization for psychotherapy is inevetable. It is likely to be the reason of all our study subjects who stated that they needed a training module for TA applications to improve the knowledge and skills of TA; although almost half of them had been using TA as an option in their therapy to treat relationship problems.
All of our study subjects expressed the need of TA applications training modules. Strategies used to improve the knowledge and skills of TA are to acquire, to explore and to follow training modules of TA applications. Our finding can be a base of a handbook, in the form of transactional analysis application modules, which can be applied in the cases of relationship problem. Effort of various stakeholders is needed to enhance the knowledge and skills of TA applications further to give a better service delivery and the patient's satisfaction can be ensured.