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  #21  
Unread March 12th, 2005, 06:35 PM
Paul Wachtel Paul Wachtel is offline
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Default 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
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  #22  
Unread March 13th, 2005, 01:39 PM
Paul Wachtel Paul Wachtel is offline
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Default 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
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  #23  
Unread March 13th, 2005, 02:51 PM
Paul Wachtel Paul Wachtel is offline
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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.).

Paul
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  #24  
Unread March 14th, 2005, 02:49 PM
Tom Rosbrow Tom Rosbrow is offline
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Default 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)
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  #25  
Unread March 14th, 2005, 09:02 PM
Paul Wachtel Paul Wachtel is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspective

Thanks for the references, Tom.

Paul
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  #26  
Unread March 15th, 2005, 01:46 AM
judypickles judypickles is offline
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Default 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
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  #27  
Unread March 22nd, 2005, 12:39 AM
Paul Wachtel Paul Wachtel is offline
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Default 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
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  #28  
Unread March 22nd, 2005, 08:50 PM
judypickles judypickles is offline
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Default 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
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  #29  
Unread March 23rd, 2005, 12:37 AM
Paul Wachtel Paul Wachtel is offline
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Default 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
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  #30  
Unread March 24th, 2005, 01:27 PM
judypickles judypickles is offline
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Default 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
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