Hi Everyone,

It is the time of year again when we are organizing our annual March workshop. This year's workshop will kick off with our usual six hour Saturday workshop, Introduction to Control Mastery that will be taught March 1st at the Jewish Community Center. It will feature our own George Silberschatz, Steve Foreman and Jan Schrieber. The week-long workshop will then take place at our Funston Avenue locations starting March 3rd through March 7th.

The overall workshop is structured with two ongoing case conferences in the mornings and two 2 hour workshops from 1 to 3 and 3 to 5 each afternoon Monday through Friday. In the 1 to 3 timeslot one of the workshops will be a series of Core Control Mastery curriculum workshops covering pathogenic beliefs, the plan formulation, testing, understanding and using dreams and on technique in psychotherapy. The remaining afternoon workshops have covered a broad range of topics in the past.

Because we would like the 2008 workshop to be as inclusive and diverse an experience as possible, we are very interested in the workshop topics that you would be interested in either attending or in teaching. While we only have limited workshops available, we want to make room for a variety of presenters and topics.

So, please email me at pwood@jps.net with your teaching interests and areas of interest. Also let me know, if you are interested in teaching, when you would be available to teach.

Your participation and energy are crucial to making the upcoming 2008 workshop a success. Think big, think outside the box and send me your interests and ideas!

Warmly,

Patsy Wood, Chair - SFPRG Education Committee

Almost every seat was taken and people were standing in Steve Foreman's kitchen Sunday night when the Town Hall Meeting was held before the Members Mambo, October 21st. We had a great turnout and a lively discussion. The Membership Committee was in charge of the meeting, represented by Kathy De Paola, George Silberschatz, Kathie Dunn, and Karen Hubble.

Kathy DePaola started off by welcoming everyone to the 4th annual Town Hall meeting and explained that the idea for these meetings came from the membership committee (committees are fertile ground for new ideas!) as well as the newsletter (which all agreed is a great success due to Kathie Dunn's editorship). Kathy DePaola introduced the board members present and they gave informal reports from the Education and Finance committees that emphasized how easy and how enjoyable it is to volunteer. Patsy Wood and Molly Sullivan updated us on the clinic and we welcomed the new interns, some of whom were present. Read On

In 1976, while completing my dissertation work at New York University, Hal and Joe asked me to join the Mount Zion Psychotherapy Research Group, an invitation that I accepted with enthusiasm and pride. That was a period of incredible excitement and productivity: the theory was being developed and refined, clinical applications were expanding, and the psychotherapy research program was in high gear, with about a dozen empirical studies in various stages of progress. The work of this Bay Area interdisciplinary group of psychoanalysts, psychologists, researchers, and experienced clinicians quickly began to develop a national and international reputation. Whenever we gave presentations there were always a few people in the audience who were intrigued by this new psychoanalytic theory that had such a positive orientation and focused on the many ways that people try to master their conflicts and problems.

However, most of the recognition for the work came from the fact that the research group had been coming up with innovative scientific methods for studying complex, often unconscious phenomena and research findings that challenged some fundamental assumptions (The sub-heading of Joe's 1990 article in Scientific American was "Rigorous quantitative studies of psychotherapy are challenging certain widely held views of how the unconscious mind works and how patients in therapy make progress".). I've been giving a lot of thought lately to how the Mount Zion Psychotherapy Research Group was able to be so productive and whether there are things that SFPRG might do to increase the level of our research productivity. Here are some of my thoughts. Read On

The following is the first part of our serialization of Alan Rappoport's article, Co-Narcissism: How We Accommodate to Narcissistic Parents. Subsequent portions of the article will appear in future issues of the newsletter. You may also view the whole article by clicking on the link provided just below.

Part I

Abstract

This article introduces the term "co- narcissism" to refer to the way that people accommodate to narcissistic parents. I use the term narcissism here to refer to people with very low self- esteem who attempt to control others' views of them for defensive purposes. They are interpersonally rigid, easily offended, self-absorbed, blaming, and find it difficult to empathize with others. Co-narcissistic people, as a result of their attempts to get along with their narcissistic parents, work hard to please others, defer to other's opinions, worry about how others think and feel about them, are often depressed or anxious, find it hard to know their own views and experience, and take the blame for interpersonal problems. They fear being considered selfish if they act assertively. A high proportion of psychotherapy patients are co- narcissistic. The article discusses the co-narcissistic syndrome and its treatment, and gives case examples of patients who suffer from this problem. Read On

One of the major benefits of moving to San Francisco from New Jersey three years ago has been learning about control mastery theory and practice. I discovered SPRG soon after I arrived here. Prior to moving, a friend of my wife suggested that we contact a psychotherapist (both my wife and I are therapists) in San Francisco that she knew and soon after coming here, my wife did meet with her. In the course of the conversation, my wife learned that this psychotherapist was a member of the San Francisco Psychotherapy Research Group who suggested we make a connection with this group.

My first exposure to SPRG was attendance at two classes at the annual March workshop. The first was led by Peter Schumacher and Norman Sohn. Dr. Sohn presented one of his own cases and invited the group to make comments or ask questions. The emphasis of the discussion that ensued was different than I expected. It was on concepts and terminology such as control mastery, testing, and survivor and separation guilt. I was intrigued by what I heard and interested by the fact that research was involved. I decided to find out more about control mastery. Over the next few years, I attended workshops, weekly courses, and read the available literature voraciously. Read On

Enrique Casero, Ph.D. was elected Honorary member of the Florida Psychoanalytic Institute and Society for his long standing contribution to teaching 3rd and 4th year candidates a course on Object Relations Theory. This is a two year course co-led with Edgard Patino, M.D. Congratulations Enrique!!

Barbara Sapienza writes that the supervisors and interns continue to settle in and get to know each other with a good solid start. It seems a blessing to begin slowly getting to know our patients before a new one is added to our caseloads. Our interns do look forward to more referrals, however. Please think of us in the next weeks and months. Barbara

Norman Sohn announced that Jessica Broitman will be retiring as President of SFPRG in April 2008. Jessica's contributions have been numerous and invaluable throughout the history of our group. Most recently her presidency has helped us bridge from Joe and Hal's founding and leadership of the group to whatever model of organization will come next. We are all in her debt.

This news raised the questions, "How are leaders chosen?", and "What input can members have regarding who's on the Board and who the Board officers are?"

This led to an interesting and lively exploration of what model of self-government we favor. There was widespread agreement that SFPRG members would like to see more transparency and have more substantive involvement in the selection process. Specifically, there seemed to be a strong consensus for the membership to participate directly in the process of electing leaders and Board members. It was noted that most professional organizations rely on a democratic model of government in which members vote, and suggested that SFPRG would be strengthened by moving toward a democratic model. When Joe and Hal founded and ran SFPRG, it seemed only natural to take our cues from them. Since their leave-taking, we've been undergoing the inevitable developmental process of transitioning to a different model of organization, with new leaders emerging as well as fresh new ideas for research projects and conferences.

It was pointed out that "our strength is in our membership". People want to be more involved and have more of a voice at all levels of the organization. It was made abundantly clear by our current leadership that all types of interests and skill are welcome and will be necessary if the new ideas for research projects, journal articles, teaching, committee work, and most especially, marketing, are going to flourish. There was a strong sense that moving toward a more democratically run organization would strengthen the sense of shared community, which would lead to greater active involvement and participation of our membership and greater growth of SFPRG.

Molly Sullivan made an eloquent and heartfelt statement of thanks to Jessica, which was roundly applauded. The meeting was adjourned and everyone went out to enjoy refreshments and conversation.

FOCUS. The focus of the Mount Zion Psychotherapy Research Group was on advancing theory through research. Somewhere along the way SFPRG has lost this focus. I'm not sure if that's because some people think that we have THE answers or that control-mastery theory is THE best theory - views that in my opinion are simply wrong and clearly not conducive to further research and theory development. Returning to our empirical focus and roots does not mean we have to become a group comprised of exclusively or primarily researchers. This was never the case in our history.

The Mount Zion Psychotherapy Research Group was comprised of just a handful of researchers and a very large group of practicing therapists and clinical teachers who valued research and who were willing to contribute their time to further the research enterprise (they did this largely through doing clinical ratings and offering clinical expertise).

LEADERSHIP. Under Hal and Joe's leadership, psychotherapy research was always an integral part of what we did and what we stood for. Unfortunately, within the SFPRG institutional structure, research plays a fairly minor, almost non-existent role. Within the current SFPRG Board, for instance, there is no research leadership or even a functioning research committee, and as a result SFPRG resources and money are spent on other activities.

In our clinic, to cite one example, it has been exceptionally difficult to carry out research studies or to make psychotherapy research an integral part of the training program; by contrast, assessing and treating Learning Disabilities has become one focus of service and training. Although the assessment and treatment of Learning Disabilities is an important topic, I doubt it is a productive avenue for furthering the control-mastery theory or research enterprise. Leadership most certainly plays a decisive role in how we allocate very limited resources and how we maximize our contributions to the field.

COLLABORATION. Robust theory and research programs generally thrive through active collaborative efforts. Optimally, such efforts would take place both within our own ranks (the SFPRG membership) and through collaborative projects with other groups. Although there is some collaboration currently going on, we would clearly benefit from a stronger organizational structure that promotes productive research and theory development programs. The inability to integrate research in our clinic and trainingprogram is a rather striking and unfortunate example of inadequate collaboration and ineffective leadership.

In summary, I believe that the control-mastery theory represents a significant clinical and scientific contribution to the field of psychotherapy. Providing education and training is certainly one important element of what SFPRG should do; however, training should not come at the expense of focusing on research. Historically, there was a clear synergy between research and clinical training - the research improved clinical work and clinical training helped to keep the research appropriately focused. I'd like to see that synergy return to SFPRG for after all, we are the SF Psychotherapy RESEARCH Group!

Narcissism

Narcissism, a psychological state rooted in extremely low self-esteem, is a common syndrome among the parents of psychotherapy patients. Narcissistic people are very fearful of not being well regarded by others, and they therefore attempt to control others' behavior and viewpoints in order to protect their self-esteem. The underlying dynamic of narcissism is a deep, usually unconscious, sense of oneself as dangerously inadequate and vulnerable to blame and rejection. The common use of the term refers to some of the ways people defend themselves against this narcissistic dynamic: a concern with one's own physical and social image, a preoccupation with one's own thoughts and feelings, and a sense of grandiosity. There are, however, many other behaviors that can stem from narcissistic concerns, such as immersion in one's own affairs to the exclusion of others, an inability to empathize with other's experience, interpersonal rigidity, an insistence that one's opinions and values are "right," and a tendency to be easily offended and take things personally.

A high proportion of people in psychotherapy have adapted to life with narcissistic people and, as a result, have not been able to develop healthy means of self-expression and self-directedness. I have coined the term "co-narcissism" for this adaptation, which has the same relation to narcissism as "co- alcoholic" has to alcoholism and "co-dependent" has to dependency. Co-alcoholics unconsciously collaborate with alcoholics, making excuses for them and not confronting them about their problem in an assertive way. The same is true of the co-dependent person, who makes excuses for the other's dependency and fills in for him or her as necessary. The wife of an abusive husband who takes the blame for her partner's behavior is another example of taking responsibility for someone else's problems. Both narcissism and co-narcissism are adaptations that children have made to cope with narcissistic parenting figures. To the best of my knowledge, every narcissistic and co-narcissistic person that I have encountered has had narcissistic parents, and the parents of their parents are reported to have been even more highly narcissistic.

To the extent that parents are narcissistic, they are controlling, blaming, self-absorbed, intolerant of others' views, unaware of their children's needs and of the effects of their behavior on their children, and require that the children see them as the parents wish to be seen. They may also demand certain behavior from their children because they see the children as extensions of themselves, and need the children to represent them in the world in ways that meet the parents' emotional needs. (For example, a narcissistic father who was a lawyer demanded that his son, who had always been treated as the "favorite" in the family, enter the legal profession as well. When the son chose another career, the father rejected and disparaged him.) These traits will lead the parent to be very intrusive in some ways, and entirely neglectful in others. The children are punished if they do not respond adequately to the parents' needs. This punishment may take a variety of forms, including physical abuse, angry outbursts, blame, attempts to instill guilt, emotional withdrawal, and criticism. Whatever form it takes, the purpose of the punishment is to enforce compliance with the parents' narcissistic needs.

Parts 2 through 5 of this serialization will appear in subsequent issues of the newsletter.

What I have learned so far about control mastery principles has greatly improved my clinical effectiveness with a keener understanding as to "how psychotherapy works". For this, I am most grateful.

In my psychoanalytic training days, when the term "corrective emotional experience" came up in the literature, it was downplayed as not being truly analytic. However, although this was a relatively simple concept, it made total sense to me compared to the vagueness and a lack of clarity of many other concepts. Control mastery theory, as I understand it, elevates the importance of the corrective emotional experience in transference and passive to active testing and its emphasis on safety.

A most helpful tool has been the emphasis of the passive to active test. In the past my main focus had been on transference testing (although I had not conceptualized this relationship as a "test"). Control mastery has expanded my horizon to the other side of the coin. I am more alert to passive to active testing; understand with more depth that the patient is unconsciously sharing and communicating important past experiences; and now know better how to respond to it in a calm way.

Control mastery has rekindled a greater appreciation for the tenacity of the unconscious. I had been focusing more on cognitive, transpersonal, and existential ways of working with some of my patients. Now my approach is more balanced in these cases.

I have found that in some cases, pathogenic beliefs around basic badness can be caused by fear, shame, and guilt induced by religious teachings and indoctrination.

Exploring control mastery, has led me to reexamine how memories can be accessed. In traditional psychoanalysis the route is through free association, dreams, slips, and interpretation. In control mastery, in general, the focus shifts to creating a safe relational place and passing tests to reach this goal, with interpretation playing a lesser role.

In the last few years I have familiarized myself with the ideas of existential psychiatrist and psychoanalyst Thomas Hora, MD. His emphasis is patient's becoming aware of their mode of being from a philosophical and spiritual perspective. Uncovering pathogenic beliefs are part of his methodology. These beliefs, however, are viewed as an accumulation of invalid and misguided thoughts about how to achieve happiness and freedom. He has written that one does not heal by remembering, but one remembers as a result of healing. ("Existential Psychotherapy: Basic Principles": IN QUEST OF WHOLENESS, 1998, PAGL Foundation Inc, page125). This paradigm is in accord with control mastery thinking, as I understand it.

Lastly, I more appreciate the pervasive role of guilt as a source of pathology and suffering in the human scene. I have observed more keenly how many patients atone for imaginary crimes by unconsciously sabotaging relationships, health, and career. This has enabled me in the first few sessions to hypothesize and focus as to what pathogenic beliefs may be operating.

Control mastery has led me to an insight as to a personal family matter. My mother-in-law lived with us during the last few years of her life. She was a loving, nurturing, related, intellectual, and artistic person. We were fond of each other. I knew that she would have loved me to call her "mom". Yet I could not bring myself to do so. I felt that I only had one mother and that to call my mother-in-law "mom" didn't feel right.

Understanding control mastery's emphasis on a child's loyalty to family members has brought me insight as to my attitude. My mother, who died many years before my mother-in- law, though she had many wonderful traits, was distant, uneducated, and superficial. Withholding recognition of motherliness to my mother-in-law was out of loyalty to my natural mother. To grant my mother-in-law's wish would force me to face guilt over disappointment, sadness, and anger about my mother's not being good enough in her nurturing.

With this insight I have allowed myself, in general, to experience a degree of this repressed disappointment, sadness, and anger about my mother.

Michael S. Isaacs, MSW, NCPsyA, JD, is a member of The San Francisco Psychotherapy Research Group. He is a psychotherapist in private practice, with offices in the Inner Richmond section of San Francisco. He is a clinical social worker and nationally certified psychoanalyst. He has a general practice, seeing young adults and adults.He finds it particularly rewarding to help patients with relationship issues-those who want to enter into a healthy one, those who want to improve or save an existing one, and those that are dealing with loss. Additionally,woking with patients who would like to add a spiritual dimension to the psychotherapy process. His telephone is 415-566-1884 and website michaelisaacs.net