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  #11  
Unread February 7th, 2005, 09:30 PM
Tom Rosbrow Tom Rosbrow is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspective

A couple of brief thoughts. Judy writes "Pathogenic beliefs might be expanded to include pathogenic cognitive-affective-somatic patterns." My thought reading this was agreement with the addition that imagery should be added into these patterns. People think in images, not just in words or cognitive patterns; our imaginations are an integral part of our psyches and how we 'picture' the world and make sense of ourselves and others. Then in the next posting Paulo Migone mentions images, though in a different way. One difficult with CMT language is that it translates emotional configurations, including images, into beliefs which sound like logical construcs, eg if I grow, then my parent will suffer. I think that Joe, a visual artist, translated imagery into scientific hypotheses as part of his creative process; as in his work on dreams where he would look for or make up the caption that fits the picture. But when we only read or express the scientific side, we run the danger of sounding dry, when implicitly there is much more going on-- this connects with what Rebecca is saying about her struggle with making the theory come to life when teaching.

Tom Rosbrow
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  #12  
Unread February 8th, 2005, 02:50 AM
Helene Goldberg Helene Goldberg is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspectives"

Thinking about Judy's point of moment-by-moment plans: I think this is an essential part of any successful therapy. The actual experience of the intantantaneous give and take created in the communication between therapist and patient is vital. In a sense, there are micro-tests going on all the time in any communication--A dance that informs and creates a relationship. Yet I think there is great value in the idea of a macro plan. In fact, I think that the greatest strength of our theory is a hypothesized projection into an imagined future. Most theories focus on analysing the historical effects of the past or on the immediate experience in the present therapeutic relationship. The idea of the plan introduces an additional notion of a direction toward the future. (The concept of resistance is about protecting the past; testing is to alter the future.) It keeps us working to understand what's going on in the larger context of comprehensible goals. By goals, we primarily talk about the patient's goals, yet there is always our own personal/interpersonal goal as a therapist of creating a constructive relationship with another person. Our idea of the patient's plan acts as a guide to how that relationship should take shape.

It may be a bias toward order or health, and as such may seem overly optimistic, yet I believe that choosing to engage in therapy is an optimistic endeavor. I also believe that to focus on the patient's tendency toward health doesn't mean we are blind to pathology. I think that the plan concept merely encourages us to keep looking beyond the meanings of the patient's behavior that are a repetition of past traumas or patterns. Even though we are fully engaged in the immediate emotional reality of the relationship, the plan concept allows us to simultaneously hold on to the idea that a patient has intentionally chosen to engage in therapy for a purpose: to have a better life outside of the therapeutic relationship with us. And that we can work with the patient to understand what that life will consist of.


And like Tom and Rebecca, I think that our literature has oversimplified the idea of tests, plans, and pathogenic beliefs by making them too literal. In Joe's writings pathogenic beliefs are presented as rational units of understanding, whereas we actually develop an almost cosmological frame of how the world works from early on. It is vast and most of it is unconscious. It is made up of intersecting (though not fully consistent) families of metaphorical connections which include everything from the laws of physics, superstition, morality, and common sense-- to anything else we use to get along in our world and our lives. They form a web of interconnected beliefs. Some strands lead to a better life; others bind us to
repeated pain.
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  #13  
Unread February 8th, 2005, 12:48 PM
Cynthia Shilkret Cynthia Shilkret is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspective

I agree with Tom (and the others) who have pointed out the gap between what we mean by a plan and how other clinicians sometimes react to the term. It would be good if we could convey more clearly the tentativeness and flexibility inherent in unconscious plans. Joe addressed the problem to some degree when he made the distinction between a "blueprint" and a "rough guide." However, I think that part of the problem is that some clinicians view "thinking" and "feeling" as mutually exclusive. A plan doesn't mean lack of conflict or lack of affect. Some students are surprised that they can formulate a plan and still attend to the moment-to-moment changes, including affective changes, in the dyad. This has become most noticeable with clinicians who value spontaneity and surprise in the therapeutic encounter. But having a plan does not make you inauthentic. (Michael Bader has written on this more eloquently than I can, but I don't have the reference at hand.) There is nothing in the plan concept that negates the intersubjective aspect of the therapeutic dyad. It will always be a specific patient-therapist interaction with mutual influence. However, control-mastery is clear that there will be limits to the possibilities in that interaction, in part, based on the specific patient's plan. (This may be one way that the theory is less optimistic than is generally thought. While the patient may wish to improve, there may be limits to what is possible based on the patient's history, and so his/her assessment of what is safe.)

Cynthia Shilkret
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  #14  
Unread February 9th, 2005, 03:39 PM
judypickles judypickles is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspectives"

I agree with you wholeheartedly, Helene. A strength of the macro-plan theory is its focus on the directionality toward a vision of future possibilities. And I would add, helping the therapist (self-regulate) hold onto a big picture of the therapy while in the grip of the field in the moment-by-moment process.

I am arguing for 1) finding language and concepts that communicate better what we all seem to be adding in various ways here in our discussion, and 2) expanding our focus to address relevant and related areas that have a developed literature of research studies and related theories that might inspire us to ask different sorts of questions that we could then study.

Some areas that I have mentioned that excite me have to do with the dyadic process of developing moment-by-moment intentions with our lens of investigation up close. And I wonder too, if there might be relationships between that close-up process and the larger plan elements that we address, as Dan Stern proposes, the micro world is like "a world in a grain of sand." For example, there is sooo much infant research and attachment research with implications for therapeutic process that I find very exciting.However, it would take some study to get into that material to see how it might be relevant to the work of the group.

Beebe et al., Beebe and Lachmann, 2002, The Boston Change Process Study Group including Dan Stern, Lou Sander, Lyons-Ruth et al.,(many papers and Stern's 2004 book, The Present Moment) Gergely, Watson et al.'s work on contingency perception and attachment (Bulletin of the Menninger Foundation 65(3), Summer 2001) and application by Fonagy et al., in Affect Regulation, Mentalization, and the Development of the Self in which they discuss their social biofeedback model of parental affect-mirroring, specifically their description of affect-mirroring styles (Fonagy, Gergely, Jurist, & Target, 2002 pp. 192-202 for an introduction to the ideas). All of this work has direct implication for psychotherapy process that we could explore.
References have been made to the idea that our theory is interpersonal and some think intersubjective. But these are highly developed concepts within psychoanalysis (Stolorow et al, Benjamin, for example), infant research (see above), and cognitive science (Thompson, 2001) that involve ideas that we have not considered. Perhaps, we should better consider what those concepts are in other realms so that we can decide whether to explore these and related ideas in the context of our body of work.

I have to go, so that's all for now.
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  #15  
Unread February 9th, 2005, 05:06 PM
Michael Bader Michael Bader is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspectives"

I rarely give much thought to a patient’s plan, and yet I believe that s/he has one. I find it difficult to imagine someone coming to me for help and simply sitting there repeating/enacting their pathogenic beliefs (in the interest of safety) and not, at the same time, have a powerful wish for the therapist to somehow provide a way out. After all, the patient isn’t coming to a barber (I should talk) but a therapist. Further,why would we want to assume that there is only some vague and general wish to feel better and not accord that wish any further intelligence? In my own research on sexuality, I have found that there is an enormously complex unconscious process underlying a simple moment of sexual arousal---scenarios are created, role-relationships are established, etc--all with the unconscious intention of bypassing or disconfirming specific pathogenic beliefs. If that’s the case, why begrudge a patient’s attempts at self-cure at least the same degree of creative agency and “planfulness?”

On the other hand, I rarely think about plans per se. I don’t ever make a “plan formulation. I would be interested in hearing from people about how specific or formal their own assessment of patients’ “plans” actually are. I mainly try to figure out and disconfirm pathogenic beliefs. And I usually know a test when I see one. But plans? It was historically useful in staking out the fact that we believe in unconscious thinking and decision making, and, so, theoretically, it makes sense. And it was and is useful in positioning us within the broad humanist tradition of seeing people as striving to get better and transcend their limitations. But how does it inform our work exactly? I don’t’ think I use it to figure out whether something is a test or how to pass it. How ‘bout others?

I realize, however, that I do think along the lines of “he’s working on trying to feel more independent and entitled” and so, in that case, I suppose that I’m implying a plan. And sometimes I find it useful in providing a rationale for the fact that people don’t work on everything at once and that there are many instances where, for example, a patient has to overcome his/her guilt about being strong and assertive before feeling safe and strong enough to tackle feelings of rejection.

So, I suppose in general it seems to me that the concept of an unconscious plan is usually a sensible “taken-for-granted” starting place or background assumption of my work but one that I rarely put any conscious thought into.
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  #16  
Unread February 9th, 2005, 05:18 PM
Michael Bader Michael Bader is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspectives"

I'd be interested in Helene elaborating a bit more about the idea of a "cosmology"...because it seems right-on the mark that although one CAN define beliefs as affectively and sensory rich experiences and even images, the term doesn't lend itself to that expanded view. But what I hear Helene saying is that, in practice, when we saying something like: "You think that if you're strong, you'll hurt women just like you felt growing up"...that we're saying--"you're entire experience of the world, the universe, the relationship between the planets, the air you breathe is the same now as it was as a child and that experience made sense then but is fucked up now--so why don't you try to gradually change that entire sense of the universe here with me....."
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  #17  
Unread February 9th, 2005, 10:28 PM
Helene Goldberg Helene Goldberg is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspectives"

Thanks Judy,

I think it would be great to study these other theories with the idea of opening up new questions. There is a lot out there and plenty of room for us to grow.
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  #18  
Unread February 9th, 2005, 10:42 PM
Helene Goldberg Helene Goldberg is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspectives"

And to elaborate a bit: As i mentioned, I see these beliefs in a complex though not necessarily consistent family of frames. So the belief that "if I'm strong, I will hurt women like my mother was hurt" can survive side by side with the contradictory belief that women are stronger than men or that my strength would make women feel more secure. These ideas could coexist with the idea that the world is not a zero sum game or whatever. Ideas can be contradictory because they are unconscious and not subject to rational, linear analysis. (I can watch the sun set, even though I also understand heliocentricism.) The illumination that occurs in therapy might throw one set of beliefs into relief or shadow-- or eclipse another set of beliefs.

Such a change can alter the (individual's) world, or to paraphrase my man Wittgenstein, "The world of the unhappy man is a different world than that of a happy man." (I hope I am not sliding too close to a post-modernist solipsism).

Last edited by Helene Goldberg; February 10th, 2005 at 02:10 AM.
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  #19  
Unread February 11th, 2005, 01:50 AM
judypickles judypickles is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspectives"

Helene,

I really like the way you put this about contradictory beliefs existing in a "complex though not necessarily consistent family of frames." I would think that the emergence of one of these conflicting beliefs within a particular frame or network would in part be "context-dependent." So if one morning I'm interacting with a women ( or simply imaging the same) who seems to me to act hurt by my strength, my old worry about hurting women (as I thought I hurt my mother) if I'm strong might likely become activated.

However, that same afternoon, if I experience a friend as enboldened and more secure by my being strong, my earlier activated worry, based an my old belief, would likely recede into the background and I would join your man Wittgenstein in thinking, my world as a happy woman in the afternoon is indeed different from my morning world in which I was inhabited by my unhappy worried state with its associated network of guilty/shameful feelings, thoughts, somatic clenching, and imagined scenarios. I can see where this kind of view might seem perspectival- or approaching a complex systems' view.

So would you please say more about your concern that you may be sliding too close to a post-modernist solipsism?

I ask because I think assumptions underpin any point of view. So you raise an interesting question about our CM assumptions as you offer this interesting expansion of multiple, possibly conflicting or contradictory beliefs, which I view as relationally, context dependent whether actually interacting with someone or alone in one's room with one's own imagination.

Judy
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  #20  
Unread February 11th, 2005, 02:36 AM
Helene Goldberg Helene Goldberg is offline
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Default Re: "Integrating control-mastery theory & research with other theoretical perspectives"

Thanks Judy,

I do see these frames as context dependent, though not arbitrary. If you have a strong pathogenic belief that your strength is harmful, you would have a slew of life experiences that would either confirm or disconfirm this belief. You would enter therapy however to make your life work better. Some of these beliefs would interfere with this. Through your relationship with the therapist you gradually and intentionally work at isolating and disconfirming those beliefs that get in your way. I think it becomes clearer and clearer in therapy which beliefs they are. The reason things become clear in therapy is both the patient and the therapist have an unconscious or conscious intent to change things, and an allegiance to their ability to understand the world. I do think that the idea of the patient's plan and our assumption that we can comprehend it is central to the theory. Not that we need to come up with the kind of systematic plan formulations that are used in the research literature. I agree with Michael; I rarely bother with this formal structure. (But then again I rarely make lists or take notes.) I would find coming up with a formal plan algorithm a distraction from the more organic understanding of the patient's plan that informs my interactions in therapy.

My joke about sliding toward the post-modernist slippery solipsism slope alludes to my analogy of watching the sun set while understanding heliocentricism. They are contradictory views of the same event, but they have very different uses and meanings. There is a real world with various ways of framing it; not an infinite set of subjective worlds.

I'm still thinking this through.
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