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Unread February 6th, 2005, 07:58 PM
judypickles judypickles is offline
Join Date: Jan 2005
Posts: 7
Default 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.

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