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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 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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  #4  
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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  #5  
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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  #6  
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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  #7  
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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  #8  
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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  #9  
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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  #10  
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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