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Unread March 13th, 2005, 02:51 PM
Paul Wachtel Paul Wachtel is offline
Join Date: Feb 2005
Posts: 8
Default 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.).

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