Thank you for giving so generously of your time in amply describing Kathy's process of recovery. I have long been a "fan" of CMT, although not quite a true believer. My problem with CMT is my conviction that it neglects important dynamic factors when describing the curative process. Happily, this has little impact on the curative process itself, mainly because CMT therapists have a marvelous way of ignoring CMT, as you did, when it fails to be pertinent to specific aspects of a patient's problem. I have harassed Jessica in the open forum in a similar vein regarding the case of Caroline, which was discussed here. There, convincing arguments were harder to make, because of Caroline's incredible abuse. With Kathy, I think the situation is clearer, as can be seen by considering the many "paradoxes" associated with this case.
Of course, no therapeutic theory embraces the full complexity of human nature, so in a sense saying that CMT leaves things out is not to say very much. But let us suppose for a moment that it is true. What would that mean? It would NOT necessarily mean that the pathogenic factors CMT therapists describe are incorrect, but only that they are being overemphasized and overextended. This is what I felt was true of the description of Caroline's case and what I feel is true of Kathy's case also.
As I say, I have no criticism of the therapeutic process, but only of the way it is described theoretically. This is a therapists' forum, so why bring all this up here? I would not bother, except that CMT does claim to be grounded in science. CMT, as far as I can tell, is scrupulously scientific in its methods. But--let's face it--scientific psychological investigations are not mathematically rigorous. The human psyche cannot be reduced to numbers, so it is quite possible to be scientific in one's procedures and still be lacking conceptually. Nevertheless, when one makes the claim of a scientific basis for certain results, it is incumbent that one's interpretation of those results be as complete and accurate as possible.
Enough preambling; let's get down to cases. Judging from your description, Kathy is very talented. She may in fact be a world-class writer at an early stage of development. Kathy said that she always wanted to be a writer, yet nowhere is this central goal in her life accorded a place in the CMT-based description of the dynamic factors influencing Kathy's behavior. Nowhere is it seen as playing a role either in her "depression" or her recovery. I believe that the help you gave Kathy in recognizing and combating her pathological beliefs was crucial to her recovery, but at least as crucial was your unwavering and enthusiastic support for the legitimacy of Kathy's identity as a writer.
I do believe that Kathy suffered from the pathogenic belief that her gaining attention meant that someone had to be harmed, but I don't see this as a crippling influence in itself. The fact is that she continued seeking and winning attention in high school and college in very competitive venues--sports, politics, journalism. She also continued seeking and winning attention in her love life. Again, I am arguing that something else participated in bringing about her "depressions."
I would like to begin talking about that something else by quoting from the writings of psychoanalyst Erik H. Erikson, who has written much about talented young people in crisis. Actually all of the quotes come from his book, "Young Man Luther," a book ostensibly about Martin Luther, but which has much to say about Freud, George Bernard Shaw, Charles Darwin, and others as well.
Erikson writes: "I have called the major crisis of adolescence the identity crisis; it occurs in that period of the life cycle when each youth must forge for himself some central perspective and direction, some working unity, out of the effective remnants of his childhood and the hopes of his anticipated adulthood; he must detect some meaningful resemblance between what he has come to see in himself and what his sharpened awareness tells him others judge and expect him to be." Kathy's identity crisis, I believe, involved her need to make her talent an integral part of her life.
Erikson uses the word "crisis" because the development of a working unity is never a straightforward process, and it becomes especially torturous when great talent is involved. It is very dangerous to put your dreams into practice, to make your dreams a fundament of your life. Suppose you did so and discovered that the talent you thought you had really didn't exist? What goal do you dream about then? What I am saying is that there is a normal tendency for someone with talent to hang back and to even be reluctant to admit to the importance of that talent in his or her life.
Erikson speaks of such people needing a "moratorium" as a way of "marking time before they come to their crossroad, which they often do in the late twenties, belated just because they gave their all to the temporary subject of devotion. The crisis in such a young man's life may be reached exactly when he half-realizes that he is fatally overcommitted to what he is not."
He then quotes William James who speaks of such people as "'sick souls' and 'divided selves' who search for a second birth, a 'growth-crisis' that will 'convert' them in their 'habitual center of … personal energy.'"
I think that motherhood was Kathy's moratorium and that she gradually came to see that she was fatally overcommitted to what she was not--or at least not only. I believe also that her first abortion was an attempt to weaken her commitment to motherhood to allow a place for writing in her life.
As evidence, following that abortion, Kathy had a "depression" of a very strange sort, strange because it was accompanied by something wonderful. "She felt vulnerable but also able to make deep emotional connections, previously unavailable to her. It was a very special time. She felt special. She felt attractive in an unusual way - not pretty or unpretty - but able to attract attention almost anywhere she went. And it wasn't that she was, in fact, any more attractive than she'd been before, but more that she was allowing herself to connect emotionally and to feel alive. These connections felt almost electrical. Before that time, when she was steady, stable, and functional, she never focused inwardly as that would be self-indulgent. But at this time she automatically connected to others and focused on those emotional connections."
Those kinds of connections many writers only dream about, because without them, they have little of any substance to write about. Kathy's talent was emerging at this time, forcing her to start making fundamental decisions about her life, and the prospect scared her, so she backed away.
"This 'special time' lasted about 8 months. Then she moved to the Bay Area and returned to focusing on externals again, although never as completely as before. She made a decision to be more stable and functional because she couldn't go on living on what she called a 'steep ledge' that felt so dangerous. What was dangerous were the feelings--not the content--but the feelings."
When you asked her why she decided to go back to the functional self, "she suddenly became so afraid she would stop mothering that she put a stop to all feelings."
Kathy had brought herself to the brink, become frightened, and backed away. But, as Erikson says, "a creative man has no choice. He may come across his supreme task almost accidentally. But one the issue is joined, his task proves to be at the same time intimately related to his most personal conflicts, to his superior selective perception, and to the stubbornness of his one-way will; he must court sickness, failure, or insanity...."
Kathy's one-way will wouldn't let her be satisfied with a life without feelings. She had tasted of the forbidden fruit and was not to be denied for long. Kathy had another abortion and another curious depression. This time, however, "the most dramatic change the depression brought was in Kathy's feelings about mothering. Although previously always intensely fulfilled by her children and her mothering, she suddenly felt intensely empty with her children. She felt resentful of what she referred to as the 'surviving children.' It was so hard to mother them. Although she disliked feeling these empty feelings, she valued highly the intense vulnerability she felt which allowed her to feel alive and connected to people in ways previously unavailable to her. She became animated and out-going in her social and work worlds. Although diagnosed with a major depression, Kathy claimed, 'I didn't feel depressed. I felt crazy. My hands would shake; I lost weight; my emotions felt out of control; I cried all the time. But I also played, had fun, and flirted with all these people. I felt very special. Then I would return home and feel lonely and miserable with the children. And I felt so guilty - here I had these three beautiful children I had always felt so fulfilled by and I wished I could be somewhere else.'"
As this statement indicates, Kathy still wasn't ready to join her talent to her life, or even to admit to herself that that was what she wanted to do, but she did take a major step in that direction. Then she took another: she sought therapy with you.
Kathy has not by any means come to the end of her journey, but thanks to your interventions, she is finally ready let her talent and life-long goals operate openly in her life.