Jeanie- you have put your finger right on the critical issues - despair- hope and hopelessness. I would also add that the level of guilt one has is a tremendous factor. The greater the despair and guilt the harder I think our work is. The more isolated one has been, with less opportunity to see alternative systems of thought and reactions, the more entrenched in the pathological system one can also be. I think you are correct in saying that when one has lost hope there is often little opportunity to test. I have seen patients leaving their success or failures to fate. I do not think that one is always testing but I do think it is often the case that one uses testing in daily life. I know my poor family and friends are the recipient of many an attempt on my part to sort something out. It can be as simple as will they remember to get me a present for my birthday? If they do not then it could confirm a pathogenic belief that I should not be treated specially. With our more disturbed patients it can take a more onerous path. “ If god wants me to live then I will not die when I jump” is the extreme form of this phenomenon that I have heard a patient say. When one is identified as you correctly point out, with the aggressor, one is not necessarily testing to see if this is the correct behavior, one is defending oneself in the only way they believe possible. They also might be complying with messages from a parent regarding how to understand and view the world. I have seen patient who have given up and it seems that these are the times when fate or luck has as big an impact as anything else. If the job comes through, if the money they needed is found, if someone says something disconfirming…. A small action or event can have a tremendous effect or not. I do not think CMT can account for all human behavior. I agree with you that we should not expect it to or try to make everything fit into it. There is the whole realm of biologically based mental illness that require medical treatments that exists in a separate domain. There are however many thing we can offer in terms of understanding how therapy works and how to help our patients. I am so glad that you have found the theory useful and I hope to meet you someday! What do the rest of you all think????
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