I want to thank you Don for presenting- it is a huge time commitment. I feel as though I have learned a great deal about your theory and know there is much more to understand. I have been collecting question so I can understand it even better. We have taken on a bold task- discussing cases from such different theory basis- yet we seem to have caring about our patients, wishing to spare them humiliation and believing in man's capacity to grow and master trauma in common. Good starting points!
From what I have read, it seems as though there aren't specific techniques that are prescribed by your theory. Control Mastery Theory also encourages therapists to develop and use a style that suits their personality. The theory also trys to teach therapists how to determine what a patient might be working on at a certain moment in the treatment. That is one use of the testing concept- If you can ascertain what the test is i.e. the conflict that is interrupting one's natural progression, a therapist can be most helpful to the patient. Is seems like this is a similar to knowing which affects are blocked, and your teaching clinicians how to read facial expressions. I hope we will have an opportunity to discuss a case where the patient's affects are being used to induce feelings in the therapist in order for the patient to learn from the therapist how to deal with traumatic situations. We call this a passive into active test sequence and pay a great deal of attention to the feelings induced in us by the patients. I think we would have fun discussing that! I will try to find a case that would provide that opportunity. Now to return to my good bye to Harold-
What a rewarding case- it must have felt good to see Harold blossom, learn to enjoy his family and be able to feel closer to them. An excellent piece of work and a good teaching tool.
I am certain that you have helped Harold and his family a great deal. Harold's insights into his somaticzations helped him to shift his style of dealing with his anxiety and discomfort. I believe that your patience and thoughtful consideration of his symptoms paved the way for his relinquishment of the symptoms. In Weiss's theory symptoms (like somaticzations) are considered for their function. After a medical basis has been ruled out, I would be thinking about how the symptom fits into the patient's need to hold him or herself back from achieving a developmental or life goal, or is seen as preventing painful affects. I think about a families style of handling quilt or difficult affects and look to see if the patient is identifying or complying with a family member.
I hear the material in this case as Harold gaining more freedom to fully enjoy his life and to take charge and regulate it so that he wouldn't become overwhelmed. I keep remembering his self-sacrificing parents who were always at the store. I would guess that his reentry problems were also the effect of guilt over taking time off not -tending to his responsibilities and worry that terrible things would happen if he took his eyes away for a second. Now this would make one tense all right!!! The "can't take it anymore days "seem to me to be times when his omnipotence doesn't allow him to relieve his burdens. He can only allow himself the needed rest in an out of control "acting out" way rather than comfortably arranging for the time off. This guarantees that he will feel bad about taking the time as it was in a irresponsible fashion that must "get him in trouble" at home or work. Thus he gets punished but for the wrong deed!.
Someone else has to make him do the things that are for him alone (like treatment) as he feels undeserving and quilty otherwise. Psychotherapy is a difficult job for one who has trouble not worrying. I know that your previous work together freed him greatly but I don't think his belief system had changed completely (or that it ever does). When he returned for a refresher to get your help to slow down (only when sent by Meg) he was asking you to help him set his "responsibility meter "down to re-ground him enabling him to feel free to live and enjoy his life. It makes perfect sense that the vacations precipitated his symptoms as they were for him. He was acting unlike his family and this is very quilt inducing. I think you would call it a life scrip (maybe Henry would see this as a fiction ) and I a pathogenic belief but we seem to be referring to a similar impediment.
So I see Harold's somaticzing as serving several functions- one of which would be causing him to remaining unhappy and having a problem so that he can continue to identify with and remain connected to a parent. I would bet that one of his parents if not both had a lot a psychical symptoms and complaints. This wouldn't have to be the case though, as Harold could have created this particular symptom for many varied temperamental as well as experience based reasons. The central feature would be to impede his pleasure and restrict his freedom to enjoy his life. Because, as you discussed, he didn't know how to read the affect signals his body gave off and correctly respond to them. He was forced to erupt and ruin his life by maintaining a symptom that keeps him from fully enjoying Meg and his life out of quilt.
Your telling him in many ways, over many days, patiently without giving up on him, that you could help him improve this problem and find relief, lets him consider shifting. Your attitude and response also indicates to him that he could still be close to you without the symptom- although I am sure he would miss his contact with you very much and would bet that is an important loss for him that would be helpful to address-what if Meg didn't send him in for a check up ? Could he come himself- without a problem. I think that would be very hard for Harold. Yet it could be an important part of the treatment. Again my thanks and appreciation for your work. I look forward to further discussions.