Integrating control-mastery theory & research with other theoretical perspectives
 

This on-line study group will begin on Friday, January 28.

Welcome
 

Welcome to this on-line study group/seminar on integrating control-mastery theory and research with other theoretical perspectives. I’d like to provide a little background to this on-line project. Several months ago I began to organize a group of clinicians and researchers to critically examine some of the strengths and limitations of control-mastery theory, developed by Joseph Weiss in collaboration with Harold Sampson. The group is comprised of experienced psychoanalysts, psychologists, psychotherapists, and psychotherapy researchers who meet every Friday for an hour to discuss the theory and research (one week devoted primarily to theory and the subsequent week primarily to research). This “Friday Group” is organized around particular topics and associated readings. The seminar format clearly limited the size of the group and our location in San Francisco limited participation to local residents. I felt that our dialogue would be substantially stimulated and enriched by involving a wider group of colleagues and therefore launched this on-line forum.

I would like this forum to follow the Friday Group format. The discussion will be organized around specific topics and related readings. To maximize the likelihood of productive interchange, participants should restrict their comments to the topic under discussion. Suggestions for new topics and readings are always welcome and should be sent directly to me.

For those who would like to read more about control mastery theory, I recommend Weiss (1993) or Silberschatz (2005), which provides the most current presentation of the theory, clinical application, and research.

I look forward to a lively, productive discussion.

References

Silberschatz, G. (Ed.) (2005). Transformative relationships: The control-mastery theory of psychotherapy. New York: Routledge
Weiss, J. (1993). How psychotherapy works. New York: Guilford.

thoughts on the concept of the patient's plan
 

Hi Everyone

In reading the dialogue between Joe Weiss and Wachtel in Psychoanalytic Dialogues, I was struck by the reference that Wachtel made to Control Mastery’s tendency to adopt the “positive” view of a given conflict experienced by our clients as a central interpretative stance. Wachtel writes:“Weiss is operating from a dichotomous decision tree in which, if the supposed more classical formulation is unsatisfactory, then his must be right.” Rather than viewing the patient’s appearance of being more relaxed after an interpretation as a passed test, Wachtel observes: “The pleasant surprise alternative – that the patient anticipated rejection and was missing sessions to ward it off but was delighted when it turned out his expectations were disconfirmed – would also lead to his becoming more relaxed and coming more regularly and it would not require making the additional assumption that the patient had this outcome in mind to begin with and was giving the therapist the chance to show he was different.” This suggests a hesitancy on Wachtel’s part to assume the lowered anxiety in the patient’s response was due to the therapist passing a test that reinforced the patient’s preconceived plan as Weiss inferred but rather was simply a result of a more immediate sense of relief on the patient’s part that the anticipated rejection did not occur. To Wachtel, the idea of a preconceived patient’s plan is a leap of faith made by Control Mastery therapists that is not substantiated by any data.

The question then arises, how do we empirically determine a patient’s intent? It seems that there are a number of avenues we have to assess this. One is self-report – the patient actually tells us that she wants to achieve a particular goal. In this case, we might question her intent based on other contextual information we had that disputes that but in the absence of that, we would likely be inclined to believe this patient. Another option is to look at behavior and see how behavior dovetails with statements of intent. If a patient tells us one thing and repeatedly does another, how do we make sense of this empirically? According to Control Mastery theory, we would make sense of it either by wondering if the patient was letting us know by telling us this goal that this was their plan and the behavior was a test to see if we, as therapists, would ignore or give up on the goal. Another possibility is that we might assume that the behavior was evidence of the patient’s true plan and their statement to the contrary was a test to see if we could look beyond the words to help the patient achieve their goal. Another avenue we have to assess planfulness is affect. If a patient tells us with much misgiving something they want we might be more likely to question it than when they tell us something with great enthusiasm. But again, we might be looking for contextual information such as identification or compliance with a parent to evaluate this data as well. In any of these scenarios, there is a strong subjective element to our assessment where as therapists we must infer our patient’s intended plan from data gathered in our patient’s statements, her affect and behavior. In order to make sense of the complexity of all this raw data, we filter that data through our model of how the mind works. For Control Mastery therapists, central to that model is the concept that patients have a conscious or unconscious plan to get better. In this way, we have a kind of tautology: we select out data on the basis of our model and then use that to further justify the model.

In looking at some of the differences between Weiss and Wachtel, there is a similar dialogue in Cognitive Science between the Bandura’s self-efficacy model (1989) and the Powers', control theory, the cybernetic model (1991). The Self –Efficacy model views humans as always striving towards goals, working to eliminate challenges and barriers to their fulfillment of their goals. They do this through as Bandura puts it “emergent interactive agency” that has self-reflective and imaginative elements to it. In this model, an interaction between personality, affect, cognition and environment all drive behavior. The Control Model, on the other hand, views humans as motivated by immediate environmental inputs that are fed through an information processing loop that then determine behavioral outcomes. It is discrepancies between the programmed state and perceived changes in input from the environment that motivate change in the latter model. In this way the control model is based on more immediate inputs whereas the self efficacy model views human motivation as having a more positive goal oriented and therefore planful aspect to it. Bandura writes, “there is a growing body of evidence that human attainments and positive well-being require an optimistic sense of self-efficacy. This is because ordinary social realities are strewn with difficulties. They are full of impediments, failures, adversities, setbacks, frustrations and inequities. People must have a robust sense of personal efficacy to sustain the perseverant effort needed to succeed. (Bandura, 1989).” Put in another way in a later article Bandura (2003) writes: “People are aspiring and proactive organisms, not just reactive ones. Their capacity to exercise forethought enables them to wield adoptive control anticipatorily rather than being simply reactive to the effects of their efforts. They are motivated and guided by foresight of goals, not just be hindsight of shortfalls.”

This tendency to side on the positive side of the conflict humans experience is at the heart of Control Mastery theory. It’s not enough to just “be” with our patients or clients in their conflict, we actually want to act as coaches to move them forward from their state of impasse and this often involves identifying a goal as the plan – we do this either explicitly or implicitly in the way we work with this patient. This focus then provides the momentum patients often need to move through their impasse and inhibitions. This doesn’t mean that we want to be glib about the conflict they find themselves in – between their desired goal and inhibitions from achieving it. Wachtel seems to suggest that the idea of a plan can be dismissive of a patient’s struggle with their conflicts. But I don’t think Control Mastery would endorse this. Often it is initially appropriate and necessary to remain close with our clients in their pain while we acknowledge and validate their discomfort. On the other hand, helping them to move past the impasse and using our authority, our positive beliefs in them, our interpretations and our unflappable stance are all ways that we take a positive stand that our clients can resolve their conflicts and problems and thereby move through them toward “their goals.” This involves assuming that their plan to achieve whatever goal they feel stuck from achieving is a viable one and sometimes the therapist naming it as their plan can be motivating to the patient, even if the plan is only inferred by the therapist (e.g. a reading of their unconscious plan).

It is difficult to get a full understanding of Wachtel’s model of the mind without reading more of his work. In his book, Therapeutic Communication he elaborates on how he views the change process in clients. He draws heavily from Piaget in his explanation which involves processes of assimilation (small shifts in perception and behavior) and accommodation (larger, more global shifts in cognition). Wachtel writes of transference as particularly important in the therapeutic process: “Transference reactions, from this perspective, are best understood as the product of schemas in which assimilation predominates over accommodation. When we describe a patient’s reaction as transferential, we are essentially saying that he accommodates only minimally to the specific qualities of the analyst that differ from his parents, and that the readiness to assimilate the experience with the analyst to schemas associated with previous experiences from early figures in his life can override many fine (and not so fine) points of difference. But the perspective provided by considering transference in the light of Piaget reminds us that the transference reaction cannot be purely assimilative. There must be some accommodation as well (Wachtel, 1993).”

It is this latter statement that coincides more with a Control Mastery model with an emphasis on more planful change. Nevertheless, if we consider how Wachtel may regard the patient relative to a plan concept, the process of assimilation and accommodation is a slow, usually lawful process that takes time and would likely involve staying with the client more in the immediate experience of his conflict/s rather than making inferential statements about where he might be going (the idea of the patient’s plan). Such interpretations would likely be received by the patient, in Wachtel’s scheme, as counterintuitive and premature and are therefore less effective in moving them towards change. Indeed, Wachtel states in Psychoanalytic Dialogues: “Patient’s way of living will almost inevitably lead again and again to experiences that seem to “prove” their validity, for, acting on the basis of those beliefs, patients will elicit behavior from others that is compatible with their expectation. In that sense, these “unrealistic” beliefs become “realistic” in the context of a patient’s cumulative life experience. A therapeutic approach that does not acknowledge this odd quasivalidity will not feel as experientially on target to the patient and will therefore be less effective in helping the patient to develop an alternative valid worldview that is more expansive and affirmative of the full range of her psychological possibilities. (Wachtel, 1998).”

While I don’t discount Wachtel’s perception that for some patients it is imperative to stay close to their experience because their readiness for change is more conflicted, I also feel that, at times, the infusion of the therapist’s energy and enthusiasm for their ability to change can provide important momentum for the patient to move through their impasses as the Bandura Self-Efficacy model implies. In this way, the therapist does play a key role, at times, in putting words to the plan for the patient as part of the therapeutic work. So as therapists, we infer subjectively what that plan is, based on our experience of the patient, put a name to the plan and often find that the patient responds in a positive way.. Still there may be times when the therapist naming the plan may feel premature to the patient. In this instance we are not likely to see a positive response from the patient. Perhaps as Wachtel implies it is premature. It may also be the case, however, that later on in the treatment it becomes clear that the therapist naming the plan up front may have served as an incentive to the patient in spite of their earlier rejection and discounting of it. In this way the Weissian view more explicitly promotes the accommodation processes that Wachtel feels need to emerge more organically through repeated interpretations of the transference in his cyclical psychodynamic model.

So where does this leave us relative to the plan concept? It seems difficult ultimately to prove the existence of a patient’s plan except through their self-report. Otherwise, as therapists, we are can only infer it from their behavior, their affects and their transference reactions to us or by observing where the patient ends up as treatment goes on. The question then becomes, is it useful to infer a plan? Are there circumstances where the therapist making such an inference would actually be harmful to the patient? I would argue that most patients are comforted by knowing that they have a plan in mind - that their behavior, affects and statements have a more underlying meaning that is adaptive and makes sense for their lives. That patients can’t articulate their plans sometimes is no evidence that they don’t exist – they may be unconscious plans in this case. However, there maybe times when the conflict the patient finds herself in is so intractable and complex that for the therapist to identify her plan to resolve the conflict and interpret this for her might feel hurtful and premature. In these instances, a more measured approach on the therapist’s part that adheres more immediately to the patient’s experience may be valuable and effective.

Patsy Wood

Re: references on thoughts on the concept of the patient's plan
 

REFERENCES


Bandura. A. (1989). Human agency in social cognitive theory. American Psychologist, 44 (9), 1175-1184.

Bandura, A. & Locke, E.A. (2003). Negative self-efficacy and goal effects revisited. Journal of Applied Psychology, 88 (1), 87-99.

Powers, W.T. (1991). Comment on Bandura's "human agency." American Psychologist, 46, 151-53.

Weiss, J. (1998). Patients’ unconscious plans for solving their problems. Psychoanalytic Dialogues, 8 (3), 411-428.

Wachtel, P. & DeMichele, A. (1998). Unconscious plan or unconscious conflict? Commentary on Joseph Weiss’ Paper. Psychoanalytic Dialogues, 8 (3), 429-441.

Weiss, J. (1998). Unconscious plans and unconscious conflict. Psychoanalytic Dialogues, 8 (3), 443-453.

Wachtel, P. (1993). Therapeutic Communication. NY: Guilford Press.

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

I am writing a response to the Psychoanalytic Dialogues discussion between Weiss and Wachtel & DeMichele. I read these papers when they were published, and at the time thought that Wachtel & DeMichele were nitpicking and not really getting Joe Weiss' concepts. This time I had a very different reaction--that they were raising vital questions coming out of a sympathetic reading of Joe and the group's ideas, which are important to address if the group's ideas can evolve and grow. Their reactions are similar to one's I've heard when teaching the group's ideas. The language around plans and tests make clinical sense and are have a personal human meaning to clinicians working within the group's culture and paradigm. When presented to people outside or unfamiliar with the groups work, 'plans' and 'tests' often sound to the outsider as mechanistic, impersonal, and more.
Writing so soon after Joe Weiss' death, I think about how playful, creative, and humorous he was, and that his use of these terms were instrinsically connected to a passionate belief in the person's strivings to undo trauma, and find conditions of safety to do so. However, he was adamant in proposing and defending his theory, which had positive and negative effects. Positively, he and Hal Sampson created a framework and paradigm which was enormously generative both clinically and in fostering and encouraging research and clinical writing. The downside is that the theory can sound like a closed system from the outside, and as Wachtel & DeMichele point out the role of affect and personal conflict can seem missing. I think, just my opinion,because of Joe's immersion in the creation of a point of view, he willfully constructed his ideas on their own terms, and was not too interested in other theories or criticisms, excepts as ideas he could debate against, or as confirmations of his ideas. This allowed him to over many years come up with a highly original set of ideas, but the downside was a certain repetitousness -- so that the terms and wordings of the theory-- which sounded like a highly original reformulation of ego psychology in 1986 when the Psychoanalytic Process came out, can sound rather mechanical, to those outside the group, today.
The plan is a great example of this issue, and raises paradoxial questions. My clinical understanding of the concept, and the appeal of the group's work to me starting back in '86, is that it is an attempt to formulate a person's dynamics from the inside, from the point of view of the patient's motivations, strivings, and attempts to work through his or her own traumas and life-historical challenges. Weiss emphasizes the case-specific nature of the plan-- that each person has his own unique set of life-themes and strivings, which are uniquely brought into the relationship with the therapist.
This was a radical shift from the clinican constructing a dynamic formulation of the patient which described the patient's psychodynamics and object relations without putting at the very center the patient's own intentions and strivings.
At the same time, the fact that testing is seen as unconscious, and that the therapist always is trying to infer and pass the patient's test, can sound like a chess game, where the patient is unconsciously trying to figure out the therapist, and the therapist is consciously and unconsciously reacting to patient's tests--- where they are not meeting together collaboratively, in a therapeutic encounter, but are more reading and reacting to one another. I know this isn't what's meant, but the language gets in the way.
Wachtel and DeMichele very cleverly put there finger on this, for me, when they say on p.440 "one might suggest that what is really being stressed by their idiosyncratic language and conceptualization is not that it is the patient's plan (patient italicized) but that it is the patient's plan.(patient italicized)". In other words, when the plan is understood as an expression of the patient's intentions and creativity you are getting Weiss's original idea-- but it can sound by the nature of the language he is describing a plan which sounds dry, mechanical, and outside the active self of the person/patient.
There's so much more to discuss, but this seems like more than enough to start.
Tom Rosbrow

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Hi

I have had many of the same thoughts about the vocabulary of our theory. I think that the simplicity and consistency of terms like "testing" and "plans" have allowed us to design research but perhaps at the expense of developing a more nuanced and evocative way of framing our ideas.

I also think, however, that though our basic underlying assumptions of patient's using the therapist to work toward a healthier and more fulfilled life may seem arbitrary to other theorists, and though it may seem that we underestimate the darker sides of the human experience, I think that this very bias forces us to continually try harder to understand all our patient's behavior in the larger context of both historical antecedants and the striving toward future comprehensible goals.

Just a brief thought

Helene

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Hi all,

I just figured out where to post this.

Building on Tom and PatsyÕs comments, I, too, will make a few introductory remarks. I think every theory illuminates certain dimensions of experience and darkens other dimensions. IÕd like to see us rethink, expand, or refine our basic assumptions as well, including our ideas about motivation Another example-- because we tend to assume a unified model of mind, I wonder how we can address multiple self states and dissociative processes in specific relational contexts (addressed in contemporary psychoanalysis, trauma theory, and embodied cognitive-neuroscience)?

We can think about what we donÕt address as well as what we do address in our plan formulation model drawing on the research findings and related stories (theories) from Relational Psychoanalysis of all stripes, infant, attachment, & contemporary, embodied cognitive, neuroscience research, and social communication theory among others. I appreciated PatsyÕs bringing in the dialogue between Bandura and Power. I also would include exploring complexity theory and related theoretical metaphors in an attempt to address a more detailed picture of processes not currently included in our plan concept that are accessible to us today : useful metaphors from non-linear dynamic systems (a process theory of stability and change), parallel distributed processing, and neural networks, etc allow us to think about the emergent, the surprising, the novel, the variable, and the paradoxical in experience, areas typically neglected in CMT but that open up new possibilities of experiencing.

(Variability in the therapeutic interaction can be seen as offering new possibilities for the self-organizing selection of new options of patterning as shifts in the weight of the many elements of a pattern allow for more flexible response, thus facilitating accommodation to new contexts.Ñthink kaleidoscope as an analogy approximation). Yet maladaptive patterns have not typically been updated in new contexts and as Wachtel and DeMichele points out there is a tension between a personÕs assimilating new experience into old, persistent ways of organizing experience and accommodating to new experiences with more flexibility than rigidity. These process metaphors and theories offer a contrasting emphasis to the more linear ideas and methods of Control-Mastery Theory and Research. Both, I think are useful for a fuller picture to consider.

Joe, Hal, and the group asked certain kinds of questions and later made certain interpretations of the data that organized one powerful way of making sense of the development of psychopathology, therapeutic action and change. The plan idea encompasses key concepts: the traumas (in a broad sense) a patient has experienced and the relational contexts in which traumatic and often repetitive relational configurations occurred, as remembered currently with a given therapist (IÕll say more about current views of memory another time); our inference of a patientÕs goals for treatment (our best attempt to understand from the patientÕs perspective but always through our own culture-bound lens, theory-driven ideas, and morality-how could it be otherwise?); the pathogenic beliefs that obstruct the attainment of these goals as we understand them (thus, we are always fallible but open (as much as we can be at a given moment) to correction in light of patient responses); the ways in which a patient is likely to ÒtestÓ his beliefs often through action (seen as asking an implicit question of the therapist) and work in relation to the therapist; and finally, the kinds of attitudes and interpretations most likely to help the patient disconfirm (what we understand as) his pathogenic beliefs and move towards his goals.

I actually find fascinating the question, how does a theory help the therapist self-regulate in interaction with a patient, given our own organizations of experience? And what about our own organizations of experience draw us to a particular theory or set of theories? Since there are many ways of Òknowing,Ó what assumptions about human nature and the world embedded in the theory- in the idea of ÒplanÓ appeal to us? What about the research component appeals to us, rather than a more hermeneutic emphasis, although I think they cannot easily be separated? Perhaps IÕll say more about this at another time.

We have a very orienting theory. However, today, I find it often constraining and reified (as well as useful to me, as one among several useful theoretical constructions) in light of the rich ideas and research that has accumulated in 45 years since CMT was conceptualized. Because the theory was developed in the 60Õs and the zeitgeist has changed, because the language of ÒplanÓ sounds static and dated to many, and as Tom suggested, because Joe was not interested in other theories that didnÕt support his own, the theory didnÕt accommodate to new ideas and research, but rather assimilated only ideas and research that supported CMT (to use PatsyÕs beautiful explanation of WachtelÕs ideas drawn from Piaget).

When teaching CM to contemporary relational psychoanalysts of various stripes, I find that many people, while appreciating our attempt to be empathic with the patientÕs goals, with our way of understanding the conflict between their hopes and dreads (to use Steve MitchellÕs phrase) i.e., between their fear of repeated dire expectations and hoped for goals (I would add, longed for experiences) are turned off by our sense of 3rd person, seemingly objective view of only linear, lawful processes. that leaves out emergent, unpredictable (even if lawful), nonlinear processes and more subtle mutual influence processes. Some acknowledge that they can even understand that our notion of a patientÕs agency in non-consciously or unconsciously testing a pathogenic belief through enactment with the therapist may occur at moments (Stern et al.Õs co-created Ònow moments?Ó) but that many other processes of change occur also and that to emphasize the testing possibility sooo much leaves out a lot, thus constraining the theory.

In CMT testing is seen as a function of the patientÕs initiative in response to feeling safe enough to test a salient pathogenic belief. Contemporary emphases on intersubjective systems implies that a test is an emergent property of the dyadic system, that both therapist and patient together co-create a context of salience in which what we see as a patientÕs testing behavior emerges in a coherent way. What was the therapistÕs contribution and the patientÕs contribution to the conditions and context that arises when the patient initiates/responds in a particular way, whether considered repetitive or developmentally new ways. The bi-directional process of being influenced and influencing needs to be more fully explored, I think. (Stern Ôs relational moves)
Daniel SternÕs Òmoment of meetingÓ might be connected to what we see as a therapist passing the patientÕs test, again a co-created emergent moment (phenomenologically) in which the therapist responds in a way that Òcarries her own emotional signatureÓ and a coherent moment of fittedness occurs. So I would suggest that based on the emphasis on intersubjectivity and systems approaches that we think of the unit as dyad-specific rather than patient-specific, acknowledging, of course, that each person in the dyad has a different role. So a relevant retrospective question for me becomes, how did the therapist and patient co-create a particular moment? I think we have always been trying to address aspects of that process.

One outcome of the Control Mastery group, as I sometimes experienced it, was a tendency to think that there was only one right pathway in both understanding and facilitating a given patientÕs Òplan.Ó(perhaps, plan possibilities? Or multiple implicit intentions that coalesce in a particular context that may be even conflicting at times? depending on which self-state is activated at a given moment. Pathogenic beliefs might be expanded to include pathogenic cognitive-affective-somatic patterns. IÕm playing with language here as I hope we all will play with different ways of conveying our ideas that move away from static, reified notions to more process notions. Leaving out the term pathogenic would broaden the concept to any cognitive-affective-somatic pattern that may range from rigidly organized (pathogenic) to flexibly organized (adaptive) in a given context.

The messy, unpredictable, sloppy context-sensitive experience from within the micro-moment by micro-moment of the Òmoving along processÓ (Stern, 2004; also see Thelen and Smith, 1994) of therapeutic experience needs to be addressed better, I think, within CM theory. We have usually foregrounded the more experience distant 3rd person position-observing, inferring, and explaining linear processes instead of including also the phenomenological experiencing 1st person perspective from within the experience that allows for more sense of emergent, embodied experiences of surprise, novelty, and variability as it is lived, dimensions where new possibilities of patient experiencing emerge, as Stern et al argueÉwhere change also occurs, whether specifically narrated or not. (See concept of implicit relational knowing (Stern, Lyons-Ruth et al, 1998 and systems ideas, 1999). If we move from being patient-specific to dyad-specific (See Bacal and Herzog, 2003 for one example of a meta-theoretical, process approach), I think we can broaden our lens to take into account a more complex system, as we try to understand how therapeutic action and change may occur at the local level within and across therapeutic dyads (also from within and from without the experiencing dyad).

The plan concept also seems a bit static in comparison to the close-up processes that have been delineated by infant researchers, for example. Beebe and her colleagues, as many of you know, have done a lot of close-up research focusing on the micro-moment by micro-moment mutual influence processes (implicit phenomena at the edge of awareness and nonverbally expressed through gaze, vocal rhythm patterns, timing, etc) of both self-regulatory patterns and interactive regulatory patterns of mothers and infants and by analogy applied to adult treatment by Beebe and Lachmann (2002) as we influence our patients and are influenced by them. Stern, Lyons-Ruth, Tronick et al have also contributed much in this arena and applications to adult treatment (See Stern,1998 through 2004) I think we need to be open to other perspectives on how therapeutic action and change occurs to open up our ideas about plan formulation and the therapeutic action of testing and pro-plan interventions. We can open up to contemporary ideas from other realms that are different or that challenge CM views. Wachtel and DeMichele do us a service by offering one such challenge from their point of view. I wonder how their thinking has evolved since their critique in 1998 that we just read. And I wonder what others are thinking?

Warm regards to all,

Judy

P.S. Just read Helene's response. Nicely put.

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

I agree that the concept of plan in Control-Mastery Theory is central. But I see it in a somewhat different way from other colleagues, who seem to see this problem from a more clinical point of view. For example, they may stress the tactfulness or appropriateness of interpreting to a patient, who is conflicted about different plans or wishes, the “true” plan (or a given plan that the analyst believes to be true). After all, the same problem applies when a traditional analyst makes an interpretation of unconscious material: the questions are not only when and how to interpret, but what to interpret, how can we be sure that our interpretation is right (we should know that interpretations never represent a prejudicial “truth”, but only hypotheses to be discussed and verified together with the patient, and this applies also to plans).
I would see the problem in another way, namely form a theoretical viewpoint. In fact, it seems to me that what we have to explain is why a patient should have a motivation to test the therapist (and/or other important figures in his life). The concept of test of course relies on the concept of plan: without a plan there would be no test. Why should someone test someone else if there wouldn’t be anything to be tested? I test someone because I want to see if my plan is right or wrong (and the plan stem from unconscious beliefs, I mean that plan and beliefs are related).
Now, a question arises here, which is the central question about the concept of plan. In traditional psychoanalysis there is the idea that people are conflicted by their own nature. Conflicts do not arise from experience, but preexist. External events add to that, shaping preexisting conflicts, for example make them worse if these events are traumatic. Examples of innate conflicts are incestuous drives, deaths instinct (more or less projected on the outside), and so on. Instead, in Self Psychology (and also in Humanistic Psychology, e.g., in Rogers) inner conflicts are seen as derived only from the outside, from traumatic experiences (i.e., traumatic to adaptive, “good” plans of the Self). The therapist’s task is simply to allow the growth of the Self (i.e., the pursuit of his plans) through the provision of a facilitating environment (or, if you want, “corrective experiences”). This view seems supported by recent infant research. Also some relational theories state the same theme: inner conflicts (or “bad objects”, bad plans, we could say) are internalizations, shadows, of bad experiences.

It seem to me that Control-Mastery Theory adheres to the latter view, i.e., posits the existence -- deep down, in the deep unconscious -- only of social, positive, adaptive plans. These are the plans that the therapist must identify and facilitate if they are inhibited by traumatic experiences that are responsible of pathogenic beliefs.

But again, even if we assume that this idea of the existence of inborn adaptive plans is correct, why should a patient be motivated to test the therapist? A patient, born with healthy and adaptive plans, might create new, maladaptive plans due to traumatic experiences, and that’s it. He might follow these bad plans and never feel the need to test the therapist in order to change them. He might not hope -- contrary to what Control-Mastery Theory tells us -- that the therapist passes these tests, because he does not have this “wise unconscious wish”, being lost forever, destroyed by bad experiences, or at least he might be seriously conflicted or confused about what is good or bad for himself.

How do we know if it is true that the patient tests the therapist in the hope that he passes his tests? One way to find out is with empirical research, but some have argued that it might be not easy to implement a research design that is able to give a clear cut answer.

I would like to suggest an idea based solely on theoretical grounds. As Liotti and myself have argued in our paper on Control-Mastery Theory published in issue no. 6/1998 of The International Journal of Psychoanalysis (“Psychoanalysis and cognitive-evolutionary psychology: an attempt at integration”, see web site http://ijpa.org/archives1.htm), conscious or unconscious testing on the part of the patient may occur only if we assume the existence, within the patient, of a set of inborn plans, a hierarchy of plans (the top of the hierarchy corresponds to what we might call instincts, and lower plans could be quite complex and detailed) that are evolutionary based and have adaptive functions. We used the concept of TOTE by Miller, Galanter & Pribram (1960), where TOTE is an acronym of Test-Operate-Test-Exit. The Test is a comparison or matching process. The entities that are matched in a Test are (a) the perceptual categorization of the environment in a given moment, and (b) the so-called "Image" of the plan. It seems to me that without the hypothesis of the existence of this (conscious or unconscious) “Image” within the patient (such as an idea of an adaptive goal, a plan, for example an optimal relationship, etc.) a test could not be activated. And this inner "Image" has an evolutionary basis. This is one of the reasons why, very likely, only adaptive plans exist in the individual, because during evolution inborn maladaptive plans shouldn't have been selected out (think of the death instinct, for example).

I thank you for your attention

Paolo Migone, M.D.
Co-editor, Psicoterapia e Scienze Umane
http://www.psicoterapiaescienzeumane.it/english.htm
Via Palestro, 14
43100 Parma, Italy
Tel./Fax +(39) 0521-960595
E-Mail <migone@unipr.it>
http://www.psychomedia.it/pm/modther/probindx2.htm

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Here are some specific thoughts I had in response to a few of Wachtel and DeMichele's critique.

HasnÕt the history of psychoanalysis been partly characterized by big swings in ideas in response to what, over time, seemed narrow or partial. So perhaps Wachtel and DeMichele are pointing to this kind of reaction in Joe as he emphasized rational processes and optimism (both conscious and unconscious) in his higher mental functioning hypothesis as a move away from an emphasis on primary process fantasy as part of a drive model and dark motives. He also swung away, as Wachtel and DeMichele point out, from Òsiding with paternal authorityÓÉ to siding Òmore with the legitimacy of the patientÕs attitudes and to emphasize the patientÕs efforts (to the point of self-sacrifice) to protect the parental figure.Ó Joe and Hal have always included as a simultaneous factor the patientÕs efforts to maintain the attachment to the parental caregiver, a self-serving need alongside an altruistic motive. (Both)

I do think like Wachtel and DeMichele, others can think that plan refers to a ÒGrand Plan,Ó when Joe and Hal were often quite clear that plan many times also referred to what I call a mini-plan in the moment of deciding, for example, which problems to tackle first and which to defer. I would see the mini-plan idea as closer to an idea of an unformulated, non-conscious, intuitive decision in the context of the evolving intersubjective, unconscious communication flow between therapist and patient. One relevant factor would involve how the patient was construing the relative sense of safety or danger in that moment of pursuing salient dimensions to him with this particular therapist at this moment. (Plan here refers to an intention on a smaller temporal scale, perhaps moment to moment.) Stern, 2004 analyzes relational moves in a very interesting way that captures many elements of this moment-by-moment fluid and messy process. For research purposes, we developed Ògrand patient plansÓ as a basis for predictive hypotheses. We all know it can be useful to hold a big picture with oneÕs lens more distant. However, I think it is also useful to bring the lens close in to experience, the lived moment, observe while in the grip of the field, and think about the mini-plans moment-by-moment. I think the lack of this distinction has caused misunderstanding that Wachtel and DeMichele struggle with. They even say (p.433, bottom), Òwhat Weiss and his colleagues mean by ÒplanÓ is probably not that different from our own conception of the therapeutic process. So their questioning whether the concept of plan leads to clarity today, I think, is a point well-taken. There is much to tease apart here. Wachtel and DeMichele object to what seems like a single-minded focus that leaves out subtleties.

CM theory given itÕs upbeat optimistic emphasis is more vulnerable to error in the direction of overlooking and possibly negating a patientÕs darker and even negative feelings. I think PatsyÕs post addressed this issue.

Judy

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Like Tom, I am struggling with the difference between Joe's written theory and how he was during consultation. When I'm teaching people seemed turned off by the language used in the articles until I liven it up with a charismatic presentation. In response to the reading I thought that perhaps the authors are struggling with the seemingly magical part of infering a plan. Sometimes there does seem to be an omnipotence on the part of the therapist which can feel like a burden. Nonetheless, with that said there is still too much emphasis (largley unconscious) in psychoanaysis on things like secondary gains and insidious drives.Though it may not do it in an elegant fashion, CMT benefits the field by focusing on the inherent drive toward wellness.
One thing I liked in the artcle was the idea that people start to identify with their pathogenic beliefs. They point out that you cannot attack them too violently at times because patients can feel lost or criticized. I think that Joe in his clinical work balanced this very well and made sure that people felt taken seriously. I don't know of any written discussion of the nuances of challenging beliefs.
Rebecca Stoller(aka Webster)

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

A couple of brief thoughts. Judy writes "Pathogenic beliefs might be expanded to include pathogenic cognitive-affective-somatic patterns." My thought reading this was agreement with the addition that imagery should be added into these patterns. People think in images, not just in words or cognitive patterns; our imaginations are an integral part of our psyches and how we 'picture' the world and make sense of ourselves and others. Then in the next posting Paulo Migone mentions images, though in a different way. One difficult with CMT language is that it translates emotional configurations, including images, into beliefs which sound like logical construcs, eg if I grow, then my parent will suffer. I think that Joe, a visual artist, translated imagery into scientific hypotheses as part of his creative process; as in his work on dreams where he would look for or make up the caption that fits the picture. But when we only read or express the scientific side, we run the danger of sounding dry, when implicitly there is much more going on-- this connects with what Rebecca is saying about her struggle with making the theory come to life when teaching.

Tom Rosbrow

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Thinking about Judy's point of moment-by-moment plans: I think this is an essential part of any successful therapy. The actual experience of the intantantaneous give and take created in the communication between therapist and patient is vital. In a sense, there are micro-tests going on all the time in any communication--A dance that informs and creates a relationship. Yet I think there is great value in the idea of a macro plan. In fact, I think that the greatest strength of our theory is a hypothesized projection into an imagined future. Most theories focus on analysing the historical effects of the past or on the immediate experience in the present therapeutic relationship. The idea of the plan introduces an additional notion of a direction toward the future. (The concept of resistance is about protecting the past; testing is to alter the future.) It keeps us working to understand what's going on in the larger context of comprehensible goals. By goals, we primarily talk about the patient's goals, yet there is always our own personal/interpersonal goal as a therapist of creating a constructive relationship with another person. Our idea of the patient's plan acts as a guide to how that relationship should take shape.

It may be a bias toward order or health, and as such may seem overly optimistic, yet I believe that choosing to engage in therapy is an optimistic endeavor. I also believe that to focus on the patient's tendency toward health doesn't mean we are blind to pathology. I think that the plan concept merely encourages us to keep looking beyond the meanings of the patient's behavior that are a repetition of past traumas or patterns. Even though we are fully engaged in the immediate emotional reality of the relationship, the plan concept allows us to simultaneously hold on to the idea that a patient has intentionally chosen to engage in therapy for a purpose: to have a better life outside of the therapeutic relationship with us. And that we can work with the patient to understand what that life will consist of.


And like Tom and Rebecca, I think that our literature has oversimplified the idea of tests, plans, and pathogenic beliefs by making them too literal. In Joe's writings pathogenic beliefs are presented as rational units of understanding, whereas we actually develop an almost cosmological frame of how the world works from early on. It is vast and most of it is unconscious. It is made up of intersecting (though not fully consistent) families of metaphorical connections which include everything from the laws of physics, superstition, morality, and common sense-- to anything else we use to get along in our world and our lives. They form a web of interconnected beliefs. Some strands lead to a better life; others bind us to
repeated pain.

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

I agree with Tom (and the others) who have pointed out the gap between what we mean by a plan and how other clinicians sometimes react to the term. It would be good if we could convey more clearly the tentativeness and flexibility inherent in unconscious plans. Joe addressed the problem to some degree when he made the distinction between a "blueprint" and a "rough guide." However, I think that part of the problem is that some clinicians view "thinking" and "feeling" as mutually exclusive. A plan doesn't mean lack of conflict or lack of affect. Some students are surprised that they can formulate a plan and still attend to the moment-to-moment changes, including affective changes, in the dyad. This has become most noticeable with clinicians who value spontaneity and surprise in the therapeutic encounter. But having a plan does not make you inauthentic. (Michael Bader has written on this more eloquently than I can, but I don't have the reference at hand.) There is nothing in the plan concept that negates the intersubjective aspect of the therapeutic dyad. It will always be a specific patient-therapist interaction with mutual influence. However, control-mastery is clear that there will be limits to the possibilities in that interaction, in part, based on the specific patient's plan. (This may be one way that the theory is less optimistic than is generally thought. While the patient may wish to improve, there may be limits to what is possible based on the patient's history, and so his/her assessment of what is safe.)

Cynthia Shilkret

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

I agree with you wholeheartedly, Helene. A strength of the macro-plan theory is its focus on the directionality toward a vision of future possibilities. And I would add, helping the therapist (self-regulate) hold onto a big picture of the therapy while in the grip of the field in the moment-by-moment process.

I am arguing for 1) finding language and concepts that communicate better what we all seem to be adding in various ways here in our discussion, and 2) expanding our focus to address relevant and related areas that have a developed literature of research studies and related theories that might inspire us to ask different sorts of questions that we could then study.

Some areas that I have mentioned that excite me have to do with the dyadic process of developing moment-by-moment intentions with our lens of investigation up close. And I wonder too, if there might be relationships between that close-up process and the larger plan elements that we address, as Dan Stern proposes, the micro world is like "a world in a grain of sand." For example, there is sooo much infant research and attachment research with implications for therapeutic process that I find very exciting.However, it would take some study to get into that material to see how it might be relevant to the work of the group.

Beebe et al., Beebe and Lachmann, 2002, The Boston Change Process Study Group including Dan Stern, Lou Sander, Lyons-Ruth et al.,(many papers and Stern's 2004 book, The Present Moment) Gergely, Watson et al.'s work on contingency perception and attachment (Bulletin of the Menninger Foundation 65(3), Summer 2001) and application by Fonagy et al., in Affect Regulation, Mentalization, and the Development of the Self in which they discuss their social biofeedback model of parental affect-mirroring, specifically their description of affect-mirroring styles (Fonagy, Gergely, Jurist, & Target, 2002 pp. 192-202 for an introduction to the ideas). All of this work has direct implication for psychotherapy process that we could explore.
References have been made to the idea that our theory is interpersonal and some think intersubjective. But these are highly developed concepts within psychoanalysis (Stolorow et al, Benjamin, for example), infant research (see above), and cognitive science (Thompson, 2001) that involve ideas that we have not considered. Perhaps, we should better consider what those concepts are in other realms so that we can decide whether to explore these and related ideas in the context of our body of work.

I have to go, so that's all for now.

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

I rarely give much thought to a patient’s plan, and yet I believe that s/he has one. I find it difficult to imagine someone coming to me for help and simply sitting there repeating/enacting their pathogenic beliefs (in the interest of safety) and not, at the same time, have a powerful wish for the therapist to somehow provide a way out. After all, the patient isn’t coming to a barber (I should talk) but a therapist. Further,why would we want to assume that there is only some vague and general wish to feel better and not accord that wish any further intelligence? In my own research on sexuality, I have found that there is an enormously complex unconscious process underlying a simple moment of sexual arousal---scenarios are created, role-relationships are established, etc--all with the unconscious intention of bypassing or disconfirming specific pathogenic beliefs. If that’s the case, why begrudge a patient’s attempts at self-cure at least the same degree of creative agency and “planfulness?”

On the other hand, I rarely think about plans per se. I don’t ever make a “plan formulation. I would be interested in hearing from people about how specific or formal their own assessment of patients’ “plans” actually are. I mainly try to figure out and disconfirm pathogenic beliefs. And I usually know a test when I see one. But plans? It was historically useful in staking out the fact that we believe in unconscious thinking and decision making, and, so, theoretically, it makes sense. And it was and is useful in positioning us within the broad humanist tradition of seeing people as striving to get better and transcend their limitations. But how does it inform our work exactly? I don’t’ think I use it to figure out whether something is a test or how to pass it. How ‘bout others?

I realize, however, that I do think along the lines of “he’s working on trying to feel more independent and entitled” and so, in that case, I suppose that I’m implying a plan. And sometimes I find it useful in providing a rationale for the fact that people don’t work on everything at once and that there are many instances where, for example, a patient has to overcome his/her guilt about being strong and assertive before feeling safe and strong enough to tackle feelings of rejection.

So, I suppose in general it seems to me that the concept of an unconscious plan is usually a sensible “taken-for-granted” starting place or background assumption of my work but one that I rarely put any conscious thought into.

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

I'd be interested in Helene elaborating a bit more about the idea of a "cosmology"...because it seems right-on the mark that although one CAN define beliefs as affectively and sensory rich experiences and even images, the term doesn't lend itself to that expanded view. But what I hear Helene saying is that, in practice, when we saying something like: "You think that if you're strong, you'll hurt women just like you felt growing up"...that we're saying--"you're entire experience of the world, the universe, the relationship between the planets, the air you breathe is the same now as it was as a child and that experience made sense then but is fucked up now--so why don't you try to gradually change that entire sense of the universe here with me....."

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Thanks Judy,

I think it would be great to study these other theories with the idea of opening up new questions. There is a lot out there and plenty of room for us to grow.

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

And to elaborate a bit: As i mentioned, I see these beliefs in a complex though not necessarily consistent family of frames. So the belief that "if I'm strong, I will hurt women like my mother was hurt" can survive side by side with the contradictory belief that women are stronger than men or that my strength would make women feel more secure. These ideas could coexist with the idea that the world is not a zero sum game or whatever. Ideas can be contradictory because they are unconscious and not subject to rational, linear analysis. (I can watch the sun set, even though I also understand heliocentricism.) The illumination that occurs in therapy might throw one set of beliefs into relief or shadow-- or eclipse another set of beliefs.

Such a change can alter the (individual's) world, or to paraphrase my man Wittgenstein, "The world of the unhappy man is a different world than that of a happy man." (I hope I am not sliding too close to a post-modernist solipsism).

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Helene,

I really like the way you put this about contradictory beliefs existing in a "complex though not necessarily consistent family of frames." I would think that the emergence of one of these conflicting beliefs within a particular frame or network would in part be "context-dependent." So if one morning I'm interacting with a women ( or simply imaging the same) who seems to me to act hurt by my strength, my old worry about hurting women (as I thought I hurt my mother) if I'm strong might likely become activated.

However, that same afternoon, if I experience a friend as enboldened and more secure by my being strong, my earlier activated worry, based an my old belief, would likely recede into the background and I would join your man Wittgenstein in thinking, my world as a happy woman in the afternoon is indeed different from my morning world in which I was inhabited by my unhappy worried state with its associated network of guilty/shameful feelings, thoughts, somatic clenching, and imagined scenarios. I can see where this kind of view might seem perspectival- or approaching a complex systems' view.

So would you please say more about your concern that you may be sliding too close to a post-modernist solipsism?

I ask because I think assumptions underpin any point of view. So you raise an interesting question about our CM assumptions as you offer this interesting expansion of multiple, possibly conflicting or contradictory beliefs, which I view as relationally, context dependent whether actually interacting with someone or alone in one's room with one's own imagination.

Judy

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Thanks Judy,

I do see these frames as context dependent, though not arbitrary. If you have a strong pathogenic belief that your strength is harmful, you would have a slew of life experiences that would either confirm or disconfirm this belief. You would enter therapy however to make your life work better. Some of these beliefs would interfere with this. Through your relationship with the therapist you gradually and intentionally work at isolating and disconfirming those beliefs that get in your way. I think it becomes clearer and clearer in therapy which beliefs they are. The reason things become clear in therapy is both the patient and the therapist have an unconscious or conscious intent to change things, and an allegiance to their ability to understand the world. I do think that the idea of the patient's plan and our assumption that we can comprehend it is central to the theory. Not that we need to come up with the kind of systematic plan formulations that are used in the research literature. I agree with Michael; I rarely bother with this formal structure. (But then again I rarely make lists or take notes.) I would find coming up with a formal plan algorithm a distraction from the more organic understanding of the patient's plan that informs my interactions in therapy.

My joke about sliding toward the post-modernist slippery solipsism slope alludes to my analogy of watching the sun set while understanding heliocentricism. They are contradictory views of the same event, but they have very different uses and meanings. There is a real world with various ways of framing it; not an infinite set of subjective worlds.

I'm still thinking this through.

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

I find Tom Rosbrow’s comments illuminating. I do think that part of the controversy (if that is the word for a discussion which, at least on my part, is of a point of view I greatly respect and admire) has to do with a “culture,” a shared language and vision among a group who work closely together, and that the terms end up feeling different to those outside the culture.
One central meaning of the plan concept as I read it that I DO share very strongly is that it is an attempt to counter the pathocentric way of thinking that had, unfortunately, become endemic to psychoanalytic discourse (and alas, still frequently is). Weiss and Sampson offered a reformulation in which the patient could be viewed much more positively, in which genuine empathy was possible because it was not empathy with a “primitive” creature or a ruined husk fixated or arrested at an early developmental level, but with a PERSON, and a person who is still creatively trying to master the traumas of his early years. That to me is VERY important and ENDURINGLY valuable. Interestingly, it is also a central concern of my own somewhat different theoretical perspective. In my book Therapeutic Communication, one of the central themes is the way that unwitting features of everyday clinical discourse are critical, accusatory, demeaning, and also how we can construct interpretations and interventions that not only avoid such unintended assaults but positively validate and build on the buds of change and the patient’s real strengths. In thinking about modes of thought in our field that converge on this theme, the work of the control-mastery group, along with the work of Dan Wile (is all good stuff concentrated in the Bay Area?) come particularly to mind.
As I indicated in my Psychoanalytic Dialogues piece and in my response to Patsy Wood in another thread, I do still have trouble with the “plan” idea (maybe because I am outside the culture). But I find myself enormously sympathetic to what I feel to be the overall spirit of the control-mastery approach in a lot of ways. Maybe cyclical psychodynamics is simply how the ideas of control-mastery theory get talked about on the EAST coast, which as Woody Allen has noted, is a different culture.

Paul Wachtel

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

Hi,

I am still getting caught up with this very interesting and stimulating discussion. George Silberschatz had alerted me to the dialogue going on and invited me to participate. I am very happy to do so, and look forward to being a participant. (Although I do not know many of you, I hope I can join in on a first-name basis, since this seems mainly to be a first-name exchange – and while on the issue of tone of communications, I want to apologize for the rather cranky tone of my earlier response to Patsy Wood’s posting in a different thread. [I’m assuming they all loop together for different participants; I haven’t done much of this kind of exchange so I’m not sure]. I had come upon Patsy’s posting depicting cyclical psychodynamics as positing that the patient WANTS to recreate the pathological pattern , is attempting to get the therapist to collude, etc. at the end of a day with various distractions and too many chores that had to get done, and I was, I realize in the light of a nice sunny morning the next day, in an irritable mood. I do still stand behind the content of what I said, but it was not said in a tone I feel good about). Anyhow, I wanted to respond to Judy’s question of how my views have evolved since our Psychoanalytic Dialogues article (I have alerted Annette DiMichele about this dialogue, and she may have her own points to add about her own thinking). What particularly struck me reading Judy’s posting is that the shifts in my own thinking have rather closely paralled the kinds of considerations that are at the center of her posting. I am presently working on a book addressing the process of psychotherapy from a relational point of view. I have increasingly come to see cyclical psychodynamics as a form of relational thinking, one that is, of course, especially rooted in the importance of vicious circles and that is also rooted in thinking integratively, reaching outside of the psychoanalytic tradition as well. But my most focal concentration in the last year or two is on the relational perspective in general, examining some of its premises, relating it to other trends in contemporary thought, etc. These reflections have brought me to many of the very issues that Judy raises in her posting. And indeed, in just the last month or two, I have been especially thinking through how this further rethinking relates to/incorporates/tries to include/is modified by the ideas of control-mastery theory. So Judy, I will be following what you have to say especially closely, and would appreciate also being alerted to other work (by Judy or by others on the thread) that has brought control-mastery thinking to bear on the relational perspective or vice versa.

Paul

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

The enthusiasm, push, giving momentum, etc. that Patsy describes is also a part of the cyclical psychodynamic approach. It is evident more in concepts such as “attributional” interpretations (chapter 9 of Therapeutic Communication) and in the discussions in chapter 7, 8, and 10 of the same book on building on the patient’s strengths, reframing, affirming and working for change simultaneously, etc. I do think it is important to lend energy and enthusiasm, and at different moments, with different patients, I do make the kind of “leap” that Patsy is referring to. There is always a certain tension (in a good sense often) between staying with the patient’s experience and working to CHANGE and EXPAND that experience in positive directions (watching always to check whether our idea of “positive” reflects our own values and visions or those emergent in the patient’s evolving experience [and, of course, trying as hard as we can to stay with the latter]).
We never know quite how “optimistic” to be with certainty. We continually explore this, test the limits, etc. and, most of all, keep trying to check this vis a vis the patient’s experience. It is true, as Patsy implies, that sometimes we are “ahead” of the patient and the patient later “catches up” with us and is grateful that we led the way. I have no problem with erring on the side of overestimating the patient and his/her momentum for change. But I do think that it is important to keep checking, that ultimately, it is the experiential resonance of what we say with the patient’s own experience and (always emerging and evolving) structures of meaning that will make the difference. If the patient feels we are gilding the lily too much, are not aware of his/her limitations, hesitations, etc., the patient will feel abandoned and not understood. On the other hand if we are TOO attentive to that side of things, then we can end up empathically staying MIRED with the patient, and ultimately doing him/her a disservice. It is a complex, dialectical process, as Patsy depicts. My guess is we both negotiate these contrdctions in a somewhat similar (that is, multifaceted) way, but there does seem to be some difference in what might be described as our default positions. I think I have seen too much psychoanalytic VERBALIZING over the years, and am somewhat mistrustful of verbal formulations that do not track sufficiently the patient’s EXPERIENCE. On the other hand, of course, the very concept of the unconscious implies that the person’s conscious experience doesn’t tell the whole story, and at times we MUST go beyond it in what we say. I agree with Patsy that at times “later on in the treatment it becomes clear that the therapist naming the plan up front may have served as an incentive to the patient in spite of their earlier rejection and discounting of it.” But I guess I am more cautious about this possibility, at least in the sense that if the patient doesn’t feel UNDERSTOOD when we convey these thoughts to him, if he/she doesn’t feel we are really talking about HIM/HER, then it is much less likely to “take” later. In this, I am increasingly intrigued with the convergence between my concerns and formulations with ideas expressed by Bob Stolorow and his colleagues about empathy, phenomenology, and the way in which new relational experience and insight are complementary perspectives on basically the same phenomenon rather than alternative approaches to the therapeutic task.
Finally, just a note on how I understand assimilation and accommodation. Patsy depicts my use of Piaget’s ideas as formulating “processes of assimilation (small shifts in perception and behavior) and accommodation (larger, more global shifts in cognition)” I don’t think of assimilation and accommodation this way. I think of them as both of the same “size” so to speak, and the difference being between “assimilating” something new as “oh, this is familiar, it’s the same old blah blah blah” and accommodation as “oh, oh, this is something different, I better change the schema a little or it won’t fit.” This is oversimplifying, of course, because as I have written elsewhere (following Piaget) every act of assimilation necessarily implies accommodation and vice versa. It is not one or the other but a balance in a process that is essentially DEFINED by the ongoing effort to resolve the tension between the two. (see my discussion, for example, of how the young child must ACCOMMODATE the schema of “dog” by the very act of assimilating a new kind of dog (say, a dachshund or a great dane) TO that schema.).

Paul

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

Hi,

Just a brief posting in response to Paul's postings. I really like the phrase "pathocentric" Paul uses in describing other models which pathologize and infantilize the patient. Weiss and Sampson made an emphatic break from that tradition by looking at the plan, which on a phenomenological level just means, to my reading,understanding the patient's goals and intentions - not goals constructed from the outside by the clinician or an ideal theory of normality. Pathocentric models also take a perspective of the person from the outside of the persons's experience, as Paul also notes. From my understanding, classical Freudian views do this, but so do contemporary Kleinian views. Generally, relational theories in general don't, though they vary among themselves in many ways.
Paul asks about where control mastery theory is contrasted with other theories. I wrote two papers and a book review which try to look integratively at the group's work and contextualize it with other relational theories, especially self psychology and attachment theory. I think all these complementary relational theories are better utilized in relation to one another, which avoids reification and overapplying certain favored psychodynamics or approaches.

Rosbrow, T. (1993). "Significance of the unconscious plan for psychoanalytic theory." Psychoanalytic Psychology 10(4): 515-532.

Rosbrow, T. (1995). "Book review. "Understanding Transference: The CCRT Method" by Lester Luborsky and Paul Crits-Christoph." Psychoanalytic Psychology 12(4): 607-610.

Rosbrow, T. (1997). From parallel process to developmental process: a developmental/plan formulation approach for supervision. Psychodynamic Supervision. M. Rock. New York, Jason Aronson: 213-238.
(also in Progress in Self Psychology,1998)

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

Thanks for the references, Tom.

Paul

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Hi Paul and all,

I'm fascinated that you are thinking about your cyclical dynamics in relational terms, which I imagine involves contextualizing these processes, a common theme, I think among all the relational approaches. I, too, am in the process of thinking through the assumptions of all these various relational perspectives: the evolving American Relational sensibility that has emerged from the blending of the traditions of Object relations and interpersonal psychoanalysis, the Intersubjective Systems perspective of Stolorow, et al., relational self-psychological theories that are contextual, relational leanings of some ego-psychologists, dyadic systems thinking of the infant research groups and Boston Change Process group, the application of nonlinear dynamics systems underlying much of the infant research and thinking, as well as underlying embodied cognitive science and brain science that is now beginning to be applied to therapeutic action and change processes. With the increasing bi-directional influence of all these perspectives, as we all engage in conversation with each other, I, more and more appreciate the uniqueness and creativity of the many articulated theories and explanations of therapeutic action and change processes (with our very different languages, assumptions, epistemologies and sensibilities) even as we are becoming more differentiated in articulating particular co-created processes at the local level of specificity that emerge in dyad-specific ways. I think it takes a lot of work and study to really understand the thinking of other theorists and how their perspective works. I think Control-Mastery ideas and cyclical dynamics contribute to both levels and speaking for Control-Mastery, I think the ideas also can be contextualized and expanded through our engagement with other perspectives with one possible outcome being... becoming a voice in an enriching, creative multiplicity or chorus of voices, each with its own voiceprint and (overtone) structure contributing to the whole, which is more than the sum of its parts. I look forward to getting more specific as we go on.

My experience of presenting a difficult case three and a half years ago at a self-psychology conference with 9 discussants from different relational perspectives (Bacal, Lachmann, Nahum, Black, Tolpin, Nebbiosi, Sampson, Coburn and Trop, the last two representing complexity theory and nonlinear dynamic systems) led me to see these different discussions as a set of creative interpretations. The patient (who was intimately involved in the whole presentation from the very first) and I poured over these discussions and the discussants' understandings of our process that led to a richly expanded sense of involvement for each of us in different ways and to an expanded sense of connectednesss and belonging, efficacy, agency, and affective range with each other, and for the patient with her family and friends. The case, discussions, and my response to the discussants (if we have enough pages left in the issue) will be the basis of an upcoming monograph of Psychoanalytic Inquiry.

So more specifically, how are you thinking about your ideas relationally?

Judy Pickles

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

Judy,

I found your whole message very interesting. Your closing question is obviously a very important -- and challenging -- one. In fact it is the topic of an entire book that I am working on, so boiling it down isn't easy. About all I can say in a few words is that for me the integrating concepts are, first of all (no surprise) the vicious circle concept that has been at the heart of the cyclical psychodyamic vision from the beginning, and second an emphasis on contextualism, which enables both the integration of different views and, important to me, a sorting out of those "relational" approaches which are, in certain respects, perhaps not as relational as they first seem from those which are more thoroughgoingly relational.

I wish i could answer your important question more adequately here, but I think I am too immersed in the overall structure of the book at the moment to disembed enough to say it well more briefly.

Paul

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Paul wrote:

About all I can say in a few words is that for me the integrating concepts are, first of all (no surprise) the vicious circle concept that has been at the heart of the cyclical psychodyamic vision from the beginning, and second an emphasis on contextualism, which enables both the integration of different views and, important to me, a sorting out of those "relational" approaches which are, in certain respects, perhaps not as relational as they first seem from those which are more thoroughgoingly relational.
wrote:

Judy replies:

I will definately look forward to reading your book when it is published. I find your second point very relevant-your sorting out process of various relational approaches...what relational aspects they emphasize, which ones are only partially relational or include both one and two-person psychologies and how, and which ones are fully contextual and relational. I think that question is relevant for Control-Mastery as well.I hope we take up this theme as a major topic of inquiry here.

I was just reading an article by Donnel Stern called the Fusion of Horizons (Psy. Dial. 13(6): 843-873, 2003 in which he describes a viscious circle or "deadlock" that he and his patient enacted and describes how their dissociated self-states (Donnel's as well)locked in together and how they found their way through. In the process he articulates his contextual understanding of dissociation and enactment. I found myself thinking of your cyclical dynamics of both therapist and patient that might be seen as becoming engaged in those moments. I wondered if his work resonates with you.

Judy

Re: "Integrating control-mastery theory & research with other theoretical perspective
 

Judy,

Yes, I find Don Stern's work of considerable interest. Most relevant to some of the ideas I am presently working on is his concept of unformulated experience. I hope to explore it further, and to examine how it relates to my own thinking, in the work I am presently doing.

Paul

Re: "Integrating control-mastery theory & research with other theoretical perspectives"
 

Paul,

Yes, me too. In the article I referred to, I liked the way he expands his notion of unformulated experience, moving toward a systems view, without using that language. Also consonant with views of memory, his unformulated experience is not a static notion of something already structured waiting to pop out or be discovered, but rather is viewed in a context in which experience is continuously created (constructed) even though some patterns (meanings) are "remarkably enduring" (as in "deep attractor states", using the language of systems theory).

In footnote 1, (p. 844), Don Stern says, " To put the point in conventional psychoanalytic language: unformulated experience can be highly structured- though never so structured that multiple interpretations are excluded. Even those structured meanings, though, remain processes. Even the most highly organized unformulated meanings are therefore, not static objects or ruts worn in the brain and never absolute, but predispositions toward certain kinds of meaning-making and away from others."

(Wasn't it Rappaport who long ago talked about process as structure with a slow rate of change, thus overcoming dichotomous arguments about structure and process?)

Anyway, I'm teaching a class today that has this article as a central focus, so I'm into it, but I can see why you are interested in his concept.

Judy