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Unread February 6th, 2005, 05:16 PM
judypickles judypickles is offline
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Join Date: Jan 2005
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Default 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.
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