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  #1  
Unread January 25th, 2005, 04:54 PM
George Silberschatz George Silberschatz is offline
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Default Integrating control-mastery theory & research with other theoretical perspectives

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

Last edited by ForumAdmin; February 2nd, 2005 at 09:55 AM.
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  #2  
Unread January 29th, 2005, 02:29 PM
George Silberschatz George Silberschatz is offline
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Default 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.
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  #3  
Unread February 4th, 2005, 09:01 PM
patsywood patsywood is offline
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Default 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

Last edited by patsywood; February 6th, 2005 at 05:20 PM.
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  #4  
Unread February 4th, 2005, 10:32 PM
patsywood patsywood is offline
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Default 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.

Last edited by patsywood; February 6th, 2005 at 05:19 PM.
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  #5  
Unread February 5th, 2005, 10:47 AM
Tom Rosbrow Tom Rosbrow is offline
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Default 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
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  #6  
Unread February 5th, 2005, 09:14 PM
Helene Goldberg Helene Goldberg is offline
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Default 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
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Unread February 6th, 2005, 05:16 PM
judypickles judypickles is offline
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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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Unread February 6th, 2005, 06:57 PM
Paolo Migone Paolo Migone is offline
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Default 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
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  #9  
Unread February 6th, 2005, 07:58 PM
judypickles judypickles is offline
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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.

Judy
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  #10  
Unread February 7th, 2005, 03:23 PM
Rebecca Stoller Rebecca Stoller is offline
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Default 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)
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