San Francisco Psychotherapy Research Group, Clinic and Training Center
Issue #1
June 15 2006
In This Issue: CORRECTION TO ARTICLE ONE!!  

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CORRECTION!! CORRECTION!! CORRECTION!!

HELENE GOLDBERG IS THE AUTHOR OF ARTICLE ONE: "DEMOCRACY ON THE COUCH."

Co-editor Kathie Dunn seriously erred in not attributing this article to the rightful person. Further issues will be more accurately proofed. This editor sincerely apologizes to HELENE GOLDBERG.

CORRECTION!!! CORRECTION!!! CORRECTION!!!

HELENE GOLDBERG IS THE AUTHOR OF "DEMOCRACY ON THE COUCH."

I apologize also to Hanna Levenson for my mistake and reiterate that future editions will be accurately proofed.

Contact me:kathiedunnmft@comcast.net

CORRECTION!!! DEMOCRACY ON THE COUCH from HELENE GOLDBERG
 
Predictors on how a person votes

Wittgenstein said "The world of the happy man is different from that of the unhappy man." A simple statement with implications for politics and psychology. Read On


PERSPECTIVES ON THE THERAPEUTIC RELATIONSHIP from Patsy Wood
 
The free debate of different views

Our all day conference on Therapeutic Relationships was a great success. We had a solid turnout of about 80 people - many students as well as practicing clinicians. The conference was held in Langley Porter auditorium which had a very cozy feel to it. Read On


WHAT'S COMING UP?
 
Education Committee News
9 & 10 Funston Ave, The Presidio

The education committee has put together a stunning post-graduate training program running from September 2006 thru June 2007. Attendees meet every Wednesday from 7:30 to 9:30 pm; the first hour is didactic, the second is case conference. Participation is limited to 15 licensed members from all mental health disciplines. Fee: $1200 before July 1 and $1500 thereafter. For more info: http://www.sfprg.org/PostGradProgram.htm


3RD SUCCESSFUL TOWN HALL MEETING! from Kathy De Paola
 
Membership Committee News

We had our 3rd successful Town Hall meeting Sunday June 11 amidst the fog and beauty of the Presidio with SPINNING WHEEL, a bluegrass band who played their lively and upbeat music with banjo, fiddles and guitars. They added immensely to the friendly ambience of the day. Read On


MEMBERSHIP SURVEY RESULTS from George Silberschatz
 
A review of ideas

Dr. George Silberschatz provided Town Hall attendees with a results summary of the survey sent out to us. Attendees were gratified to here the results and reiterated their support. Read On


NAMING THE NEWSLETTER from co-editors
 
Some name suggestions

We've had several suggestions from which to choose. Please add others and/or make comments on those presented here. C'mon! Get Involved! Read On


THE SFPRG INTERNSHIP TRAINING PROGRAM from Zohar Itzhar-Nabarro
 
Program dream is fulfilled

In October 2002, we fulfilled one of our biggest dreams when we opened the new Control Mastery Training Center at #10 Funston. In addition to training in Control Mastery for local clinicians the Center provides interns from psychology, social work and MFT milieus. Read On


Con't: Democracy On The Couch
 

When George Lakoff was developing his idea of political frames he found that the best predictor of how a person will vote is connected to what he thinks about hitting kids. It turns out that whether you are a liberal or conservative depends on your theory of infant development and the family. For conservatives, one of the most influential writers isn’t David Brooks, Bill Kristol or Grover Norquist, but James Dobson of Focus on the Family. A writer so successful he needs his own zip code. And his views? Let’s just say that in an effort to make his teachings more humane he admonishes his followers not to start beating their children with sticks or whips before the age of 18 months.

Lakoff’s thesis is that our political views are formed within frames of meaning that are projections of our earliest experiences of authority, morality, and community in our first “government”-- the family. It turns out that whether you are a democrat or republican is related to how you think the family works and how kids should be raised. For Lakoff, the morality that arises from a strict father model shapes a conservative world view, and one that reflects a nurturing parent model informs a liberal one.

Now this is a psychological theory. It includes a version of infant development, human behavior, and cognition. So let’s look at the metapsychology behind it.

For Lakoff, the cognitive structures formed from early family experiences also turn out to be central to your political philosophy and whether you are a pessimist or optimist, conservative or liberal. Conservativestend to believe that children are born basically antisocial and greedy and that they must be coerced into behaving in a socially acceptable manner. What’s more, if you are a conservative you believe that the world is basically a dangerous inhumane place and the best you can do for your kids is to instill respect for authority and discipline, and teach them that it’s every man for himself in a dog-eat-dog world. And of course, you believe that this is the only truly realistic view of the way the world works and any other is naive.

What gives this conservative view so much power is that it reflects a theory of human nature that sees man as split between the enlightened rational mind and the dark powers of the primitive unconscious. And if you were to look a little closer at this model I think you would see a generally accepted folk metapsychology generated from Freudian psychoanalytic theory: the idea that the unconscious mind is a dark cauldron of seething drives always ready to boil over; it is the stuff of daytime tv and psychological thrillers.

Now there is a more optimistic view that posits our underlying nature is more or less benign, sometimes distorted by deprivation and trauma perhaps, but, it predicts that human beings, if given half a chance, would live productive and peaceful lives. This theory may seem a bit naive in times like these, but it has the advantage of explaining why we haven’t rendered our species extinct, that we still seem to take care of our children and we don’t kill our neighbors. (speaking locally of course.) This optimistic theory of human nature happens to be gaining dominance because it turns out to be consistent with contemporary research on infant development, brain studies, and ethological observation. And of course it has one obvious advantage over pessimism: namely, that the best pessimists can hope for is to be wrong.

But! Just as politics are not free from their psychological underpinnings, neither do psychological theories arise in a vacuum; they reflect their particular political climate.

If we look at the beginning of the twentieth century--the period in which psychoanalysis arose-- we see that it was an extraordinarily turbulent time in modern history. In general, there was a growing clash between the ideas of modernism and tradition, along with a growing fascination with the forces of the irrational and the unconscious. Writers like Nietzsche were openly attacking the primacy of logic, morality, and civilization; in both art and politics there was a growing excitement about technology and military power that contributed to the various fascist movements.

Freud was especially curious about new experiments with the unconscious mind. He travelled to Paris to watch Charcot’s demonstrations of hypnosis because they provided vivid proof that man’s behavior could be governed by forces beyond his awareness or control. Freud did not invent the unconscious: his idea of the unconscious mind arose out of the ashes of the age of enlightenment and a sense that the powers of reason were not without their own limits.

No, what Freud came up with was psychoanalysis as a bridge between the clarity of reason and the murkiness of the unconscious: a method that allowed him to use reason as a way to decipher the unconscious but without changing the essential view of its primitive bestial nature.

The classical ideas in Freud’s original psychoanalytic theory are a mixed bag of optimism and pessimism. Freud portrays human nature as greedy at its core and ready to fight tooth and nail against any insight or change. Metaphorically, the unconscious mind is a force of darkness and antisocial by nature, and must be brought into the light before it can be defanged and its energy harnessed into sublimation.

Health lay in the possibility of making the unconscious conscious. Freud’s unconscious functions not with what we know as rational thought but by “primary process” a nonlinear amalgam of symbolism, displacement and condensation familiar to us in dreams and madness. But even Freud realized that he had underestimated its full scope, and that, by portraying a gulf between the rational and unconscious mind he was leaving out the essential role the unconscious plays in all thought. In the last few decades research in cognitive science has shown us that the unconscious mind and emotion plays an essential role in decision making and creative thought, and that furthermore, metaphor (a function of primary process) turns out to be a key conceptual structure in any understanding of the world.

But when the political reality changed, so did psychoanalytic theory: when Freud and most of the psychoanalytic community were finally forced to flee Hitler’s Austria and Germany, a transformation took place in the focus and the formulation of the unconscious mind that had enormous implications for our understanding of the basis of human nature. In England, at the Hampstead Clinic, Anna Freud studied children who had lost their parents and survived Auschwitz-- children who hadn’t the luxury of working through the family drama of the oedipus complex. What she found amazed her: these kids adapted to their harsh reality with astounding resiliency; they made use of the little they had and found strength in their relationship with each other and survived intact human beings.

Now, we already had theories of infant development that were based on the assumption that babies had to be forced to adapt to reality and give up their fantasies of gratification; they offered quite compelling and titillating ideas about how the mind arose from the chaos of infancy. Freud had drawn a picture of the infant embarking on a veritable tour through a series of sexual stages: from oral, to anal right up to genital. His view of child development was a sexually charged bodice-ripper that culminated in the defeat and final resolution of the Oedipal complex. Heady stuff. Klein and her followers envisioned an even more sensational model. In her theory the infant has to endure a fantastic trek through psychopathology to reach maturity. As a sort of foreshadowing of the DSMIV, the poor babe had to be ready to assume the paranoid, schizoid and depressive positions just to make it to kindergarten.

As projections of adult preoccupations, these are fertile constructions, but they didn’t really match up with what doctors saw when they actually looked at real babies. And none of these theories could have predicted the results Anna Freud found at the Hampstead Clinic-- that the primary drive of the children she studied was to unflinchingly face and adapt to a real though utterly hostile world that allowed not the slightest withdrawal into fantasy and to survive relatively intact against all odds.

It’s unclear whether it was looking at real kids, or their own personal experiences of adapting to a more open culture, but psychologists began to shift their focus away from the fantastic world of the id to the reality based ego and its defenses.

In America, the change was more radical. It was as if, freed from the constraints of Vienna and Berlin, psychologists broke out of their own stifling isolation into the larger world. As they were freer to participate and were integrated into an open and democratic society in America, their view of the unconscious seemed to expand too.

Leaving aside the traditional wings of the psychoanalytic institutes which attempted to keep a more Freudian than thou fundamentalist thing going, you can see a radical transformation from Freud’s rarified conflicted view of the relationship between the unconscious mind and the world to the more pragmatic and optimistic ideas that evolved into the increasingly more humanistic theories of Rogers, Perls, and Maslow. This change was manifested in Hartmann’s ideas of “conflict-free areas of development” and Holt’s view of “adaptive regression” as they reconsidered the role of the unconscious mind, itself, in adapting to reality rather than seeing adaptation as a monopoly of the ego or conscious mind. This evolution not only reflected a liberal and optimistic view of human nature inherent in our democratic ideals; but it also reflected the new scientific research that was changing our definition of the roles of both conscious and unconscious thought.

It was in this social and intellectual context that Control-Mastery Theory arose. If Freud’s early theory could be seen as reflecting the pessimism and turmoil of Europe before and during the two world wars, Weiss and Sampson’s writings were nurtured by a far more hopeful period. At the end of the second world war, America basked in the prosperity following the New Deal and the allied victory over fascism. Americans believed that a progressive government could improve man’s lot and bring order and peace to the world. Children of immigrants and the working class could buy homes and attend college through the GI bill. It was a time that paved the way for a creative surge in intellectual pursuits and cultural creativity that reached fruition in the sixties. It was also a time that valued the importance of security and believed in man’s abilities to thrive if given safety and nurturance. And it was a time that allowed for a reexamination of the nature of the human mind.

In his seminal short paper, “Crying at the happy ending,” Joe Weiss laid the foundations for a new perspective for the scope of the unconscious mind. The implications of Weiss’s observations, that people are free to experience repressed emotions only when it is safe to let one’s guard down, opened the way to see the unconscious mind, itself, as weighing experience and adapting to reality. It overturned Freud’s idea that repression was a defense of infantile cravings from the harsh reality of the world and, critically, replaced it with the idea that repression can act as a protection to help one adapt to the world. Weiss’s theory is that the fundamental human impetus is adaptation to reality rather than avoidance of it, and furthermore, it assumes that humans are fully engaged in their physical and social world from infancy. And unlike the earlier theories of infant development spelled out by Freud and Klein, Weiss and Sampson’s view that babies are fully tuned into their surroundings is consistent with what the contemporary baby watchers like Daniel Stern and Allison Gopnik have actually found in their labs.

This is a far more optimistic and pragmatic idea of human nature and the unconscious than Freud’s. For one thing, Weiss assumed that psychopathology arises as a function of pathogenic beliefs that interfere with our ability to adapt to the real world. And so psychopathology is a failed effort at adaptation. Beliefs are pathogenic not because they are a defense against reality, but as a response to a reality that is no longer operative or useful. What is crucial to this theory is that, unlike drives, beliefs can be changed when they get in the way. And that is why people come to therapy and why therapy helps.


Con't: Perspectives on the Therapeutic Relationship
 

The day started out with Patsy Wood talking about the therapeutic relationships as it as been viewed historically and in the literature. The talk looked at various models for thinking about the therapeutic alliance, its correlation with outcome, client variables and therapist variables and also the research on rupture and repair. This talk was followed by our first speaker, Dr. David Burns who represented the cognitive behavioral model of treatment. Dr. Burns discussed the role of empathy in cementing a relationship with a patient so they could better engage in the tasks of CBT. He spoke of how the alliance also had been correlated with greater completion of homework assignments that had also been found to be important for reducing distress.

Following Dr. Burn’s talk, Dr. Hanna Levenson spoke about the Time-Limited Brief Dynamic model of treatment. She spoke of the importance of doing a thorough assessment in order to identify the cyclical maladaptive patterns (CMP) that became the central focus of the brief treatment. Dr. Levenson emphasized that interpretation wasn’t necessarily that helpful as it often could come across as demeaning to a patient. She cited Dr. Fromm Reichman who said: “what the patient needs is an experience, not an explanation.” Dr. Levenson also stressed the importance of taking into consideration the cultural issues that often impacted how the client interacted with the therapist. Hanna stressed that it was essential to sort out what part of the relational pattern came from the culture and what part was not driven simply by culture but was maladaptive for the client. She noted that both client and therapist bring their cultures into their interaction with each other and that each cultural contribution and its interaction needs to be carefully considered when formulating a treatment plan. Dr. Levenson emphasized that clients will reenact their most prominent prior traumas in their interactions with the therapist and that a focus on the current interaction is what is most valuable. She also stated that that if the therapist focuses on the most salient problematic interpersonal patterns, this will have a cascade effect on other maladaptive interpersonal patterns. What the therapist has to do is to not become hooked into the patient’s drama and to be able to be a participant-observer in order to be most helpful to the patient and enact with them a healthier way of relating that can generalize into the patient’s life.

Following an hour-long lunch, George Silberschatz took the stage and very coherently laid out the basic assumptions of control mastery. He spoke at length about the plan concept, the role of pathogenic beliefs in psychopathology and the importance of three ways that the patient will disconfirm these beliefs in therapy. First he stated that having a more positive experience with a therapist can disconfirm pathogenic beliefs. Second he noted that the patient can disconfirm his or her pathogenic beliefs through repeated testing that the therapist passes. Finally, making use of new information or insight can also aid the patient in disconfirming pathogenic beliefs. Dr. Silberschatz stated that any and all of these can be helpful n disconfirming pathogenic beliefs and helping the patient to feel more able to go after desired goals.

Dr. John Young of Langley Porter then presented a very interesting and successful two year therapy of a young woman. He spoke of his affection and pride for this patient and the extensive work she had done on herself in therapy with him. After the case presentation there was a short break followed by the three presenters discussing the case from their theoretical orientation. Dr. Burns emphasized that he would focus more on building an empathic relationship with the patient and then exploring with her which troubling symptoms she wanted to focus on. Once the patient had identified the most problematic symptoms which he speculated might include her drinking, compulsive sexual experiences, feeling overburdened by her family etc., the therapist would then target interventions that would most address those symptoms. In this process creating a strong therapeutic relationship was essential to motivate the client to continue the work. Dr. Levenson discussed how she would develop a formulation. She discussed the cyclical maladaptive patterns that she felt were most manifest in the case description . Dr. Levenson also spent some time talking about the significant role that culture and assimilation may play in this case as the woman was a Chinese woman who had come to the US from Vietnam when she was 4 years old. She continued to live with her parents and family as was often common in her culture. So Hanna emphasized the importance of considering how some of her difficulties may be her experience of straddling two worlds – the world of her family and the world of the United States.

Finally, Dr. Silberschatz reviewed some of the patient’s pathogenic beliefs and the interventions that had been pro plan and why that was the case. As it was a case he had supervised he had a particular familiarity and understanding of the patient’s dilemma. The last hour was spent in a panel discussion where the audience asked questions of the speakers including Dr. Young. The were a wide variety of questions and some honest debate about different ways of viewing the relationship and working with the relationship issues. The conference ended on a positive note and it seemed that every speaker had an opportunity to give their vantage points about the questions the audience raised.

We hope that that we continue to have such conferences in the future where the free debate of different views of doing therapy can be aired. On behalf of SFPRG we also encourage our members to sign up as early as possible for conferences so arrangements can be made that best accommodate the needs of the audience.


Con't: 3rd Successful Town Hall Meeting
 

We were updated by various committee chairs about the results their projects, such as the membership survey and the newsletter.

We are happy to report that many of the suggestions members made at the previous town hall meetings have been implemented,such as the new Post Licensing Credential Program starting this September and this newsletter which has been created by Priya Parmar and Kathie Dunn.

We were also happy to hear that our low fee clinic has served an increasing number of people and that we have new interns coming this fall.

The education committee reported new classes being offered and the membership committee reported that we are looking for specific volunteers in specialties such as web site design, graphic arts and marketing.

Please think of those who you know, including yourself, who may be able and willing to donate some time. Thanks for all those who came and grilled and exchanged ideas in the fog.

Membership Committee News.


Con't: Membership Survey Results
 

The number of responses follows the item in ( ).

More regional (East & North Bay, East Coast) conferences, study groups, peer consultation (11)

More social opportunities (9)

Training and/clinical conferences on CD (4)

Become a national (i.e., APA) CEU provider (3)

More national exposure and promotion of CM (3)

A newsletter (3)

More Saturday conferences with senior teachers/clinicans (2)

More referrals (2)

Resources on the website for practitioners

Application of CM for low-income clients

Serious mental illness

Broader involvement in running the SFPRG

New energy in the group

Link with other psychodynamic approaches

More community spirit; less politics and jockeying for position

Larger membership

Run the group in more business-like, professional manner

More research publications

List of senior supervisors

More convenient location

HOW CAN SFPRG BE MORE RESPONSIVE TO YOUR NEEDS

Make the directory more useful by listing areas of specialty, population served, languages spoken (4)

Peer consultation groups (3)

More effective and regular email contact (3)

Strengthen & develop East Coast presence (2)

Free training to under-funded agencies

Disseminate the theory more extensively

More recognition for clinic supervisors and teachers (yearly reception)

Presentations of CM at national and large regional conferences

Provide CM materials and training for graduate programs

Weekly case conferences

Develop a post-graduate program

Get an organizational consultant

More integration with social work nationally

CMT and multicultural issues

Prepare a synopsis of main CM research findings for patients

More advance notice for workshops and trainings (via email)

Upgrade the quality of CEU offerings

ADDITIONAL COMMENTS

Need newsletter/regular email contacts (3)

More research opportunities (2)

Several people expressed gratitude/appreciation for SFPRG

March workshop is very valuable but inconvenient to have it during the work week

Love the March Workshop

Need a post-grad program for folks who are already practicing

More low-fee referral sources


Con't: Naming the Newsletter
 

Here's the current list:

Relational Monitor

Interconnection Commentary

Passive Into Active

Testing 1, 2, 3

The Passing News

Mastery News

Process Notes (This is the name of the original newsletter)


Con't: SFPRG Training Program
 

The goal of the internship program is to help students gain skill and sophistication in working in a variety of treatment modalities and with a variety of techniques. Treatment and technique is determined by a client-focused and case-specific process of assessment, treatment planning, psychotherapy process and outcome research.

The training program runs from September to August under Dr. Barbara Sapienza, the Training Director and Dr. Jessica Broitman, the Executive Director. Dr. Molly Sullivan came on board in April 2006 and will take an active role in running the training program next year. Dr. Marshall Bush serves as the Research Director and Dr. Michael Lowenstein serves as the Medical Director.

The program is a CAPIC-approved internship site for psychology graduate students and attracts a growing number of applicants each year which demonstrates our emergent reputation in the community as an excellent placement. Currently, the program is unable to pay the interns, but we see it our number one priority to get funding to support a paid internship.

The training program is comprehensive and exciting involving case conferences, didactic trainings, and an exceptional amount of individual supervision by esteemed colleagues from the community trained in Control Mastery theory.

Interns that express interest in research are encouraged to participate in the Control Mastery Research Group activities and receive additional supervision in leading their own research project. We created an open, fun, and safe environment which facilitates learning.

This year’s interns kicked off the first annual appreciation cocktail party, a new tradition to thank those who contributed to the training program with either/or supervision or leadership of training activities.  The party was hosted by:  Joan O'Brien- Hakim, Mary Kay Hunyady, Mia Salaverry, Michelle Skeen, Rachel Chester, Terri Roberson, Trevor Graham, Zohar Itzhar-Nabarro, Jessica Broitman, and Barbara Sapienza. The party was a great success.

We established a low-fee psychotherapy clinic serving the community which is the center for clinical training and research. The interns provide clinical services and participate in research activities. This community resource offers affordable psychotherapy to individuals, families and couples.

This year we expanded our child and adolescent services and next year we will add Psychoeducational assessment for learning disabled children, adults and their families under the supervision of Jack Davis who will be the Director of neuro-developmental educational assessment.

Sliding scale fees from $25 to $90 per session are based on client income at the clinic and training center.

Community referrals are welcomed. An intake consultation can be arranged at (415) 677-7946 Ext. #1.

There are several ways you can support or get involved with the training program. On our wish-list:

o Teach a seminar or lead a case conference

o Provide individual supervision to interns.

o Call Barbara Sapienza (415) 332-6533

Referrals to the clinic (adults, couples, children, and to a therapy group)

Chairs for therapy rooms to replace existing ones

Psychological Testing materials

A wifi-ready computer

The current supervisory staff: Stan Steinberg, MD; Priya Parmar, MD; Steve Foreman, MD; Michael Lowenstein MD; Alan Rappoport, PhD; Norm Sohn, PhD, MFT; Marsha Herman, PhD; Helene Goldberg, PhD; Harriette Grooh, PhD; Janice Cumming, PhD; Carol Drucker, PhD; Kathryn Pryor, PhD; Molly Sullivan, PhD; Tom Rosbrow PhD; Patty Rosbrow PhD; Susan Badger MFT; Kathy De Paula MFT; Peter Schumacher MFT; Suzanne Banford, PhD; Sheryl Hausman, PhD; Paul Ransohoff, DMH; George Silberschatz, PhD; Patsy Wood, PhD; David Auld, PhD; Lewis Engle, PhD; Marshall Bush, PhD; Jessica Broitman, PhD; Barbara Sapienza, PhD; Melanie Clark MFT; Don Fenn LCSW;



Participate!! Comments, opinion and submissions are heartily encouraged!! Send to Priya Parmar MD at siamesekitties@sbcglobal.net.

Also, remember to update your publications for the SFPRG website and send in the hard copies.

Look for Issue #2 on July 15, 2006


Priya Parmar MD; Kathie Dunn MFT, co-editors
San Francisco Psychotherapy Research Group, Clinic and Training Center

Phone: 415-561-6771
Fax: 415-677-7946
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