San Francisco Psychotherapy Research Group, Clinic and Training Center Newsletter
Issue #23
May 21, 2008
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First, an apology to members and subscribers for not having a newsletter last month. Computer problems!! As always we are looking for your articles, opinions and announcements. Happy reading!

OUTGOING PRESIDENT'S LETTER
 
From Jessica Broitman

Dear Colleagues:

As many of you know, my term as president ends June 1st when Steve Foreman will be taking over. Steve has great enthusiasm for our group and I am certain he will be an excellent president. He takes the helm in the midst of many possibilities for the future of the group, even though challenges remain. I wish him all the success in continuing what I started.

As I leave office I find myself reflecting on our history. I have been involved with the group since 1980, when I was first introduced to Control Mastery Theory through Jane Dulay. She brought Irwin Gootnick on board as a supervisor for the day treatment program we both worked at (Creative Living Center) which served over 350 chronic schizophrenics. I was immediately inspired by the predictive power and clinical usefulness of the theory. I am eternally grateful to them both! I wrote my first fan letter to Hal Sampson and was invited to join the research in progress. I started working with Marshal Bush on the Mrs. C case and continued on to do my dissertation on insight in the therapeutic process. The rest is, of course, my 28-year history of studying with Hal Sampson and Joe Weiss and the members of the group. Read On


INCOMING PRESIDENT'S LETTER
 
From Steve Foreman

Dear Colleagues,

I am honored and excited to begin my duties as president of SFPRG in June. I am taking over the leadership of the organization from Jessica, who has done a heroic job in her leadership role over the past 20 plus years. She has navigated this organization through difficult waters as we have made a transition from being a founder organization under Joe and Hal's leadership to an organization that is governed by a board based on work done in committees. In the last four years, since Joe's death and Hal's retirement, we have been redefining ourselves as an organization, revising our structure and bylaws. We have all searched our souls to understand what this group means to each of us, what we want from the group and what we are willing to do for it.

I came to this group in 1984. I had been in supervision with Irwin Gootnick as a psychiatric resident at UCSF. He told me, "You should meet this group at Mount Zion led by Joe Weiss and Hal Sampson. They are doing some very good work." I met with Hal and shared a research paper I had written with Charlie Marmar at UCSF. Hal's comment was, "This is very congenial, very congenial with what we are doing here." I wanted to get a career investigator award and Hal recommended I contact George Silberschatz to supervise me. I started an association with Hal and Joe, and the (then) Mount Zion Psychotherapy Research Group attending seminars, getting supervision, participating in research projects, and teaching courses. Read On


AN OPEN LETTER TO SFPRG MEMBERS
 
From Melanie Clark

Dear Members,

You may or may not be aware there is a mounting crisis within the Board of Directors of SFPRG, regarding how to proceed forward with our two functions of clinical training and research validating Control Mastery Theory.

As you know - and as is part of our name, SF Psychotherapy Research Group - research is how our theory has been developed, refined, and validated. In today's marketplace, with the dominance of managed care demanding brief, behavioral treatments, research can support the voice of sanity, making the case for healing, not just temporary bandaids.

The current crisis on the Board threatens to split SFPRG into two separate organizations. According to the rumors, that is exactly what is under discussion at this point. Read On


EDUCATION CORNER
 
From Patsy Wood

Hi Everyone,

The Education Committee has reviewed all the course evaluations for the March workshops and they were very favorable overall. However, in order to get a better sense of how useful the workshops have proven to be, we have sent out a follow-up survey to all March workshop participants to get a more detailed picture of their experience and its utility for their clinical work. We are interested to know how attendance at the workshops is furthering your clinical work and those of other participants. This will help us as a Committee to develop workshops for next year that best meet the attendee's needs.

The Education Committee is also working on finalizing a marketing plan for our of fall workshops, case conferences and research seminars. There are three fall workshops that are currently planned. A four hour workshop at the San Francisco JCC on Aggression, Cooperation and Status Seeking: an Evolutionary Approach is being co-taught by Dr. Heather Clague and Dr. Helene Goldberg. This should prove to be a dynamite workshop with two outstanding presenters. On October 11th, an Ethics workshop will be taught by Dr. Jules Bernstein at 9 Funston that will meet Continuing Education credits for social workers, MFT's, psychologists and psychiatrists alike. Dr. Bernstein is always a favorite and provides an opportunity to get all of your legal and ethical questions anwered in an intimate setting. Finally, last but not least, we have an Introduction to Control Mastery workshop taught by Dr. Steve Foreman on Sat. October 18th at the JCC. Dr. Foreman has the ability to make Control Mastery readily understandable and to seem do-able, even for new clinicians. This workshop should prove to be a must for graduate students interested in the theory as well all new clinicians and those interested in reinvigorating their control mastery approach. Read On


TRAINING CENTER CORNER
 
From Barbara Sapienza

Dear Colleagues,

I am writing to let you know what great pleasure i have had during these past five years working with the first interns trained specifically in Control Mastery Theory. As I ready myself to leave the training program, I wanted to let you know the joy that I felt and continue to feel as each intern therapist successfully goes on to practice with his or her strong voice. In that vein, we have just said goodbye to Beth Kita and Amy Basford, and Virginia Todd has just passed her licensing exam. All of them have begun private practices in the area and welcome your referrals. I will introduce the rest of our graduating class in July! Read On


RESEARCH CORNER
 
From Marshall Bush

I have a summer reading recommendation: For members who are intrigued by the question of how someone develops the capacity to stand apart from the crowd, become a humanitarian, think independently and creatively, and work relentlessly on solving important scientific problems, I highly recommend Walter Isaacson's biography of Albert Einstein. Einstein's psychology shines through in a very inspiring way, as does his love affair with the violin.

Also, If you want to be inspired, go see a documentary called "YOUNG AT HEART". It will take your breath and your heart away.


RESEARCH NEWS
 
From George Silberschatz, Ph.D.

Historically, our research group has relied on rating scales that require both conceptual and clinical familiarity with control-mastery theory (e.g., The Plan Formulation Method, rating the degree to which tests are passed, rating the plan compatibility of therapist interventions). Such measures have, of course, been extremely important in our research but they are nearly impossible for anyone outside of our group to use. I believe that we have not paid adequate attention to developing scales and other rating instruments that could be used by investigators, therapists, and teachers outside of our relatively small group. The development of such scales would almost certainly make some of our concepts more accessible to a wider audience of clinicians and researchers. The Interpersonal Guilt Scale (O'Connor, Berry, Weiss, Bush, and Sampson, 1997) is an example of one self-report measure developed by the SFPRG that has received attention in the research literature. I will briefly describe two recently developed measures that show considerable promise both for research studies as well as for clinical and teaching purposes. Read On


THE EXPERIENCE OF THE THERAPIST
 
From Alan Rappoport, Ph.D.

In creating Control-Mastery theory, Weiss and other theorists have focused their attention on the patient. The issues that occupied them were the nature of psychopathology, how the patient works in therapy to overcome his or her problems, and what the role of the therapist is in this process. These issues have been well addressed over the past thirty-or-so years, and a significant body of research and clinical experience has been accumulated supporting the validity of the theory. One of the next steps to be taken is to consider the experience of the therapist, and the quality of the interaction between the therapist and the patient. There has been a great deal of interest in this topic in recent years, which is often included under the general term, "intersubjectivity."

"Countertransference" is a term that is often used to refer to the experience of the therapist. In my view, this term might most profitably be reserved for situations where the therapists feelings from his or her own past prevent him or her from acting in an appropriate and helpful way with the patient. However, that is only the smallest aspect of this issue. The therapist is always reacting emotionally to the patient, most commonly to the benefit of both parties. This is the "stuff" of psychotherapy that makes it work, and which makes it alive and compelling. Read On


ANNOUNCEMENTS
 

George Silberschatz is giving an all day control-mastery workshop in Seattle on Saturday, May 31. Click on the link below to see the flyer.

Stan Lipsitz is exhibiting a number of his photographs about the passage of time in Italy, titled Scene di Italia at Caffe Centro, 301 South Park, SF, until May 30. He also has a photograph in the pinhole camera show at Tayko Gallery, 428 3rd St., SF. This show closes June 3.

Mark your calendars for these upcoming SFPRG Saturday Conferences in the Fall:

9am - 1pm, JCC September 27 - Aggression, Cooperation and Status Seeking; an evolutionary biological look at fundamental human motivations, with Heather Clague and Helene Goldberg

9 - 2 pm, SFPRG office, October 11 - Ethics, with Jules Burstein

9 - 4:30pm JCC October 18 - Introduction to Control Mastery Theory, with Steven Foreman (and others tba)


OFFICE SPACE FOR SUBLET
 

Beautiful, spacious psychotherapy office available in Victorian building in prime Cow Hollow/Marina location on Union Street. The office has bay windows, fireplace, great light, high ceilings and is in a suite with other psychotherapists. There is a waiting room, utilities and cleaning are included. The office is available all day Mondays and Fridays and until 2pm on Tuesdays or Thursday. Please contact Lynn Byk for additional information at 415-931-3079.

Sublet available in 1939 Divisadero: I have an office in Suite 2 that is available on Mondays, Wednesdays, Thursday mornings, and Fridays, and possibly weekends. It is an inside office which will be away from the construction noise. It is furnished with 2 chairs for clients, a therapist's chair, large desk and an analytic couch. Please pass on this information; I am hoping to find someone to sublet a minimum of 2 days. Judy Schiller, 415-563-4315, jdschiller@comcast.net

Sunny, medium size psychotherapy office in Victorian suite: waiting area, separate staff bathroom, signal lights. $850/month plus utilities and janitorial. Looking for someone at least 3 days (any day except Friday) or to assume the lease with the possibility of renting back Friday to current tenant. Please contact Judith Wilson,415-221-4584, j.wilson.phd@gmail.com

Lovely East Bay, Market Hall office to sublet, or share available T/Th. 260 sq ft, $630 (which is 2/5 of my rent). Antiques and tasteful furnishings, extra high ceilings and windows on 3 sides. If you would also be interested in sharing my SF office on the opposite days, MWF $690 that would be great too. Contact Jamie Edmund, 510-547-8450.


Con'td: Outgoing President's Letter
 

What a wonderful experience it has been. I feel blessed to have had the opportunity to learn from them, and to contribute to our organization and help it grow. It has certainly changed from being a 10-person group (started in 1972), which could easily fit into one room at Mt. Zion Hospital, to the over 400-person organization it is today. Some of my highlights of our history include:

In 1986 after Joe and Hal published their first book, we held our first March workshop and it was a great learning opportunity for both the group and the 30 visitors who came to spend the week with us! Now in its 21st year this week has consistently been a great success. Originally Hal and I coordinated the teaching schedules but this is now done through the education committee.

In 1988, the Board changed the name from the Mt. Zion Psychotherapy Research Group to the San Francisco Psychotherapy Research Group (SFPRG) in preparation for our leaving Mt. Zion to become a free-standing organization. We had learned that Mt Zion Hospital was about to be absorbed into USCF, which meant a number of changes for us including that they would be taking a large portion of our grants for overhead. This was something I cared deeply about as my family foundation was going to take that hit!

In 1989 I incorporated SFPRG into a non-profit, membership-based organization (501c3). This allowed us to receive funds directly from our members and avoid the feared overhead charges. We became a group of over 200 researchers and clinicians whose dues helped fund our administrative costs. The members were then, as they are now, psychoanalysts, psychiatrists, psychologists, social workers, marriage and family therapists and other mental health professionals. Many books and articles have since been published by members of our group.

In 2000 SFPRG established a low-fee psychotherapy clinic to serve the community. Lynn O'Conner and Gilbert Newman were instrumental in helping me to begin the clinic housed at the Wright Institute. Joe and Hal felt it was crucial for the theory's survival that there be a place where we could train clinicians to learn and practice control mastery theory. We started with just two interns: Jane Weisbin and Susan Landes (both of whom now teach and/or supervise for us) and we now typically train ten interns per year at the Center. Over 40 interns have participated in treating more than 500 patients. I will be continuing on as the executive director of the clinic next year but I hope others will step forward to carry on into the future.

In 2002, SFPRG fulfilled one of Joe's dreams by opening our own Control Mastery Training Center in San Francisco's Presidio. In addition, SFPRG established a low-fee psychotherapy clinic there to serve the community. This was the culmination of two years of my negotiating with the Presidio to receive discounted space so that we could bring a psychotherapy clinic to the Presidio. Our name changed to the San Francisco Psychotherapy Research Group, Clinic and Training Center to reflect the new activities. The following year I was able to arrange for us to add another building to our lease doubling our capacity. Kathy De Paula took the lead in remodeling the building, turning it into wonderful offices.

In 2004, following Joe's death and Hal's retirement, we began meeting with our members in Town Hall meetings, and that year we developed a five-year plan to ensure our stability. It contained the following elements: 1) SFPRG's Viability: finding funding to ensure our stability; 2) Clinical Training and Clinic: a commitment to support and expand our services; 3) Member Services: development of more activities and opportunities; 4) Research Activities: encouraging and promoting more research projects; and 5) Educational and Community Outreach activities. The membership committee conducted a survey to learn what our members wanted most. As George Silberschatz reported to the Board, most members who responded asked for more regional (East Bay, North Bay, East Coast) conferences, study groups, peer consultation and more social opportunities. In addition, you told us you wanted more ways for us to communicate with each other and in response we started this very newsletter (thank you to our editor Kathie Dunn!) and a member bulletin board. I am very pleased to tell you that the subscriber list started with our 186 members and has now expanded to 451 subscribers. I invite each one of you to become a member as we welcome and need your experience and energy as we move into the future. Opportunities and benefits abound and a visit to our website (click on the link below) will provide you with the means to join.

Last year, in response to our five-year plan, we revised our mission statement: "To improve the practice of psychotherapy through the further development of Control Mastery Theory by educating mental health professionals, conducting research on psychotherapy, and providing mental health services to the community." Currently the Board is working to bring our By-Laws up to date, and in that process the Board has agreed on all but a few By-Laws changes. We are also in the process of creating next year's budget. The budget is created with input from all Committee Chairs. We utilize best practice financial protections to ensure that no malfeasance occurs. This includes having an outside bookkeeper that does the bank deposits and writes checks, a treasurer who checks the monthly statements and a certified public accountant who reviews it all.

As I think about our history it amazes me how much we as a group have accomplished. Since Joe's death and Hal's retirement, the Board has had to grapple with difficult decisions regarding the directions for growth and how to allocate our very limited funds. This is a normal stage of development for all organizations when their founders leave. The Board has supported all components of our mission statement, and I am certain that we will continue to do so. In my yearly letter to members I expressed my pleasure about what I see on the horizon. I stand by that assertion. Even though there is much more to do and there are concerns and unanswered questions, I see so much that is positive and that I am proud of. I believe that there is room for all of our interests to be served.

We have had some daunting tasks to accomplish these last few years, and some remain, and I feel we are in the process of navigating our way. During the next few years we will have to create a new plan for the next phase of our group. We believe that we will have to move when our current lease is up in 2011 as all indications are that the rents at the Presidio will be prohibitive. That means we need to begin right away to plan for a change. What a wonderful opportunity to think creatively about our future. Our organization is strong and committed; our members have indicated that they want a greater role, which I hope will add much needed energy and many ideas.

As I said in my letter to the members, the task is clear: we all want this theory to grow and develop in order to help as many as possible. Research will help us understand how best to help our patients, and improve and validate our theory. Funds are hard to come by, and by all means possible we need to raise money to help support research for the group. In addition, knowing how to use our theory with the most diverse patient populations - from child to aging adult, couples, families, eating disordered, dual diagnosis, chemically dependent, to learning disabled, (and this list can go on) - will serve us well. Knowing how to teach our theory in culturally sensitive ways will serve future generations of therapists. Clearly, these activities take resources in both capital and people's effort; we must continue to increase both. Therefore, we need to begin fund-raising in earnest and develop marketing strategies so we can continue to grow and support all of our activities. In addition, we are seeking other creative ways to increase our income. All components feed each other and are vital to our future.

As I leave office I am optimistic that we can continue to develop and join together to keep Control Mastery Theory alive. The gifts that Joe and Hal gave us are too valuable to be put aside. I would like to emphasize that it is crucial that we do not get caught up in struggles over which activity is most important. They all are. We are all passionate about this group and control mastery theory. Let us use that passion to find productive, professional and healthy ways to work out our differences. Please continue to lend us your support and send your suggestions for improving our group and our community. Help us develop and grow this wonderful and powerful theory and spread it all through the world. I hope you feel as I do, that this organization is a valuable resource for the membership and the community.

I close with a profound, "thank you!" Serving as your president was a great gift. I appreciate the opportunities it offered me, and the trust you placed in me. Best of luck to Steve!


Cont'd: Incoming President's Letter
 

That collaboration, at the time, was like a door opening. Joe's theory and its clear, accessible language taught me a way of doing therapy that was more useful and promising than any other model I had learned so far. In addition to Joe and Hal, I got to know a whole community of intelligent, talented colleagues who were similarly learning, doing research, and teaching this model. What struck me was the consistent experience of how appreciative so many of these colleagues said they felt for the theory, the community, and the collaboration. Of course, much of this appreciation was directed at Joe and Hal, who were smart and kind parent figures. But I also felt a growing connection and appreciation for my peers, who presented in Joe's case conference, or presented at the Society for Psychotherapy Research, or who met at the Wednesday or Friday conferences.

When I think about what is important about SFPRG today, I feel a continuity with how I felt 25 years ago, that this model is important and promising. It means a lot to me when patients tell me they get more help than they ever got in previous therapies because of this model. (Some of them are aware of the theory; some aren't.) It means a lot to me when students or supervisees tell me how much the theory and the group has helped them with their patients and clients. It is a thrill to greet March Workshop participants who come back to San Francisco year after year for 10 or 15 years because they appreciate the theory and the people who teach it.

The fact that SFPRG is one of the only groups anywhere to have done systematic, rigorous research on the process and outcome of psychodynamic psychotherapy is an extremely important part of who we are and means a lot to me. Our group has studied brief therapy and psychoanalysis, adults and children, process and outcome. We have done numerous case analyses looking at moment to moment changes in therapy showing that patients have plans, that researchers can infer those plans and can predict when patients will get better after therapists make interventions supportive of those plans. SFPRG has done studies of how patients test by expressing poor insight in patterns specific to brief therapies or psychoanalysis. Our group has done research on interpersonal guilt and investigated principles of Control Mastery Theory by applying new research from the fields of animal behavior and evolutionary biology. It is our research that makes Control Mastery Theory more than a religion or a fad. Our model requires much more research to validate what we think we know and to clarify what we don't know. For me, research is a fundamental component of who we are and what we do.

In 2002, we started the SFPRG Clinic, mostly due to the creativity, energy, and vision of Jessica, but with the help of many other people. The Clinic has been very successful, training more and more interns every year, with excellent reviews from trainees and patients alike. The Clinic has offered a profound new dimension to SFPRG, moving it from a teaching and research organization to a provider of low-fee clinical services. In addition to its clinical offering to the community, the training program offers another opportunity for SFPRG to teach clinical principles of CMT to new, young clinicians. The Clinic also offers an opportunity to expand research opportunities and do process/outcome studies with an accessible population.

I would like to say a few more things about Jessica, who has served this organization so selflessly, energetically, and effectively. I have known Jessica since before she got her Ph.D. when I was a rater for her dissertation. She threw herself into the middle of planning every conference we put on. She helped plan the marketing, hand carried the printed fliers to be posted, and often introduced the speakers. Money from the Broitman foundation supported the organization for years to pay for secretarial/administrative staff to plan and promote the teaching program, before we were a membership organization and even after. She and Hal planned the March Workshops every year and scheduled the teachers, rooms and supervisors. She was in the middle of every administrative decision and innovation, from hiring lawyers to write bylaws for SFPRG, to incorporating SFPRG into a non-profit membership organization, to moving to our current location in the Presidio and brilliantly negotiating affordable rents. She almost single-handedly created the SFPRG Clinic and ran it with help from a dedicated staff and teacher pool.

Her most difficult task has been to preside over the transition of our organization since Joe's death and Hal's retirement. As the purpose and direction of the organization became decided by all of us, not just defined by Joe and Hal's vision, the direction of our group was challenged by ideas and wishes of many different people. As the leader, Jessica maintained her vision, and presided over a process to help the group define itself. That included SFPRG developing a strategic plan, holding many board retreats to hammer out our mission statement and clarify how our committees and board would function, engaging board consultants, starting town hall meetings for the membership, supporting a newsletter, and facilitating a full dialogue of members and board members. Jessica led the group through this process honestly, energetically, and selflessly while battling illness for over two years and resisting the divisiveness of political disagreements on the board. The more closely I have worked with Jessica, the more I have developed tremendous respect for her knowledge, her intelligence, and her devotion to this organization.

At this transition point in our group's experience, what is encouraging to me, is how many people in our group share the same appreciation I feel for the clinical theory, the body of research, the opportunity to continue to learn and to continue to teach. Even though Joe is not here anymore, his insights continue to help all of us do better work with patients. And we see the same light bulbs go off in the students we supervise or who attend our seminars and case conferences that we and our peers felt.

When I think of what I want to see happen in the next five to ten years, I would like to see us continue the March Workshops to our national and international colleagues who have come for years as well as to new people who are learning the theory. I would like to continue a strong academic program of conferences, courses, and workshops that integrates new developments in therapy and theory with Control Mastery Theory. I would like to see research discussed, planned, and completed that furthers and challenges the theory. I would like to see the Clinic continue to thrive, training more interns, treating more patients, and bringing in more money to support itself. I would like to reach out to more students and clinicians in the Bay Area and elsewhere, to come to learn about Control Mastery Theory, and also to do research and teach.

When I look at the strengths of our group, our education program is strong. Our March Workshops are successful. Our Clinic is excellent. Even so, each of these could be better. We need better marketing for our education program and I would like to involve more of the membership, and I invite you to become members of SFPRG, in order to make good use of their expertise in presenting better classes and conferences. The Clinic is going through some transitions and we need to have better marketing and patient flow, particularly in the late summer after the old trainees leave and take some of their patients.

SFPRG is doing some research, with some members actively writing and publishing while others are frustrated. Our group would benefit from a review of what research questions are currently being addressed and which questions need to be pursued. There are members in our group who have expressed interest in doing research but don't know who to contact or how to proceed. We need to resurrect a research committee and to address the research needs of the group in a more systematic way.

SFPRG has some serious challenges in the years ahead that need to be addressed. Our lease runs out at the Presidio in the next four years, at which time the rent will become prohibitive. We need to answer the question of where we will locate and whether we will continue to house the Clinic together with the group of clinicians who currently occupy the same space. We need to answer the question of money. How we will pay for the administrative help, program, and rent we currently have? We are currently functioning with the help of a surplus of money provided by the Clinic over the past few years. Two of the positions, the clinic director and the training director were previously donated for free which is changing this year. The board has voted for a token salary of $20,000 for each position starting in June. We can pay for the expenses of our organization for the next 3 or 4 years based on current income and the savings built up in the last few years but we will need to bring in more money or cut back services after that. Our task is to bring in more money from the Clinic, increase membership to increase income and expertise, raise money through fundraising, or apply for grants.

We have these challenges and others. The Board has spent a tremendous amount of time in the last 2 years discussing structure and practice. SFPRG has bylaws and amendments to the bylaws. We have discussed refinements to the bylaws that have yet to be resolved, which I hope to address early in June. A suggestion has been made to change the voting structure of the organization to include members voting. This suggestion needs to be clarified, discussed, and acted on, another business item that needs to be addressed in June.

We need help from our membership, teaching, doing research, helping on committees, writing for the newsletter. We need financial help, including a serious thoughtful approach to fundraising. I would appreciate those of our members including, spouses, friends, etc. who are knowledgeable about fundraising to contact us and help us. And those who are not yet members with expertise in these areas can contribute greatly to themselves and to our group by joining SFPRG. I appreciate all of you on the Board and in the Membership who have already expressed awillingness to help. I appreciate your good wishes, your past efforts, and your future efforts. I want to thank those on the Board, and those who are teaching, supervising, training interns, and doing research for all your efforts. I want to thank Jessica for your tremendous achievement and great heart over the last 20 years. To the Board and Membership, I look forward to leading SFPRG over the next three years with the benefit of your energy and your good will.


Cont'd: An Open Letter
 

At the Town Hall meeting last fall, there was a strong consensus for the membership to participate directly in the process of electing Board members and officers. Currently, the Board simply elects itself. In my view, we need more explicit accountability from the Board to the Membership. And we need to have a formalized process in the SFPRG rules, laying out how members can weigh in on issues that affect us all, such as this possible split within our organization. For the Board to be elected by the Board, creates an unsupportable risk of factionalism and fractionalization. Our new paradigm should be informed by the phrase, "collaborative and collegial".

This Newsletter is a forum for everyone who cares about SFPRG to express their views. If our group is to continue to pursue both clinical training and research as Joe and Hal originally envisioned, we all need to get involved and find a way to work together for the good of the theory we love. I hope you, too, will express your opinions in this forum, whatever they may be.

Below is the letter I sent to the Board on May 2, 2008:

Dear Board Members:

Rumors abound that the conflict within the Board has reached such a pitch that there is talk of a split within SFPRG. When the Board tried to vote in the new VP, the vote was evenly split. CLEARLY, this vote should go to the membership at large.

I do not understand why the general membership is being kept out of this very significant discussion. I personally know colleagues who have let their membership lapse because of the lack of democracy in our organization.

There was considerable enthusiasm at the Town Hall meeting last fall for the Board to be elected by the members at large. That desire should be implemented IMMEDIATELY. The membership is not in any way being represented by the current Board. In addition, the functions of research and training are both needed for SFPRG and Control Mastery Theory to thrive in today's psychotherapy environment.

They need to be funded in an evenhanded way.

Very sincerely,

Melanie Clark, MFT


Cont'd: Education Corner
 

In addition, we are waiting to schedule the Schema Therapy-Control Mastery Workshop that will be taught by Dr. George Lockwood and Dr. John Curtis. We hope to offer the workshop in early winter of 2009. Again this combination of therapeutic models as well as these esteemed presenters are bound to be sensational.

Finally, please feel free to let me know your ideas for future workshops that you would like to attend or for workshops you might like to teach or co-teach. We can help develop and organize your workshop desires so don't hesitate to contact me with your ideas! We also could use your marketing muscle and insights in our efforts to expand and systematize our marketing campaign for our workshops and case conferences. And we can use additional help on the Education Committee should you be interested in joining our team. Let us know! Thank you for your time..

Sincerely,

Patsy Wood

Chair - Education Committee


Cont'd: Supervision Corner
 

I first started my work with the clinic when we were housed at the Wright Institute where Jessica Broitman, Lynn O' Conner, Gilbert Newman and other contributors were working to create a training program. Then, we moved to the lovely 9 Funston when Hal and Joe were still practicing. With their blessings and your support I began to find my strength as a mentor. I thank you dearly for all the help you have offered me in creating this program. I know that that your support of the clinic will continue as Carol Drucker takes on the role as training director.

I will complete this academic year through to the end of August, freeing up ten hours a week to devote to my private practice, painting, writing, taiji and grandparenting. I will remain a supporter, a consultant, and will be supervising one intern.

Again I thank you and hope you will carry the spirit of a great training program in any way that you can.

With best wishes,

Barbara Sapienza


Cont'd: Research News
 

The Therapy Session Rating Scales. These scales are designed assess the patient's and the therapist's experiences of therapy sessions. There are patient and therapist forms, each containing 30 parallel items (e.g., Patient form: "What my therapist did was helpful; I felt attached to my therapist; Therapist form: "What I did and said was helpful"; "My patient felt safe with me") and a general assessment of overall functioning ("How well do you feel that you are doing psychologically/emotionally today?"). Ratings are completed after every therapy session by the therapist and patient independently. Our Norwegian colleague, Per-Einar Binder, has translated the scales and started using them. He sees this as a very promising measure and his students and trainees are apparently finding them to be extremely useful clinical tools. Beginning next month, Jessica Bolton will begin to gather data on these scales at two outpatient clinics in Oregon.

The Pathogenic Belief Scale (PBS). To date, the Plan Formulation Method has been our only tool for assessing a patient's pathogenic beliefs. This case-specific (idiographic) method requires clinically experienced control-mastery therapists to read transcripts of early therapy sessions and then describe the patient's pathogenic beliefs. The PBS represents a broader, more general (nomothetic) approach to identifying pathogenic beliefs. The 59 items that comprise the PBS were generated from the plan formulations that we have previously developed. Beliefs that were stated in an individualized manner in plan formulations were reframed in a more general way. Consider, for instance, the following beliefs derived from completed formulations: 1. he believes that his girlfriend will feel threatened if he is more successful than she is; 2. she believes it would be disloyal to her sisters if she lives in a more affluent, desirable neighborhood; 3. she believes that it would be wrong to be more successful than her parents. All three of these are represented in the PBS as "the patient feels/believes that it is wrong, threatening, or disloyal to surpass one's family or significant others." By reframing idiographic beliefs in a more nomothetic manner it was possible to include a wide array of pathogenic beliefs in this 59 item measure. Each item is rated (on an 8 point scale) for how applicable it is to a particular patient. In its current form, the PBS measures 9 different "clusters" of pathogenic beliefs (e.g., guilt, omnipotence, shame, perfectionism, excessive worry). The Scale will be used to identify a patient's primary pathogenic beliefs (i.e., those items that are most highly rated) and once those have been identified, the scale can be used to assess how much progress the patient is making in disconfirming (or developing greater control over) the beliefs. I have been testing the PBS to assess how well clinician judges can agree on their ratings and how well the PBS identified beliefs correspond to pathogenic beliefs formulated in the idiographic manner. The results to date are extremely encouraging and exciting.

If you would like to try these scales out (clinically or for research purposes) or if you would like to volunteer to do some ratings with these scales for our research studies, please email me: George.Silberschatz@UCSF.EDU


Cont'd: The Experience of the Therapist
 

There are a number of areas in which is important to consider the experience of the therapist. For the therapist, the most fundamental area is whether he or she enjoys the work and derives satisfaction from it. This is a critical issue for the therapist to face, and it also has great significance for the patient. The patient is very interested in the therapist, because he or she is hoping that the therapist will serve as a model of the kind of healthy behavior that the patient is hoping to become free to engage in. If it is an issue for the patient to be free to enjoy his or her life, which it is for many of our patients, it will be very important to the patient that the therapist is enjoying his or her life. The patient will investigate this, by observation and by direct inquiry. The patient may wish to know how it is that the therapist feels safe and able to do so. The therapy may succeed or fail on this aspect of the interaction.

Commonly, the patient's parents were dysfunctional in some significant way, which resulted in a limitation on the patient's freedom to enjoy his or her life. Usually there were also some important ways in which the parents were defensive which limited the patient's freedom. It will be important for the patient that the therapist not have the same kinds of defensiveness. Optimally, the therapist should feel safe and open in interacting with the patient. Therapeutic techniques can easily appear defensive to patients. An authentic response is very likely to be therapeutic, whereas a "therapeutic" response, if inauthentic, will not help the patient. For example, in my training I was told never to answer a patient's question without first investigating the patient's motivation in asking it. In practice I have found this to be awkward. It can put the patient on the defensive, and it makes the therapist seem defensive as well. Answering the question first and then investigating is more natural and helps the patient feel freer. Often, the patient explains their motivation spontaneously when the question has been answered, as a result of feeling safer following the therapist's openness.

I find it very orienting to think of myself as modeling the kind of interactional style that the patient would like to acquire, that is, candid, open, empathic, not overly responsible for others, and free to be assertive in my own behalf. When I am considering how to respond in a particular situation, I first guide myself by this principle, and then by my knowledge of the history and dynamics of the patient.

Patients very frequently suffer from an unrealistic sense of responsibility for others. If the therapist is not satisfied with his or her life and does not seem to be enjoying it, the patient may become worried about the therapist and have his or her own progress limited as a result of survivor guilt.

I suggest we either widen our definition of "countertransference" to include all emotional responses of the therapist, or eliminate it entirely, since keeping it in its present form requires us to distinguish between "healthy " responses the therapist may have and "unhealthy ones" which should be kept to a minimum, "worked through," and hidden from the patient if possible. Including all emotional responses of the therapist as important and legitimate parts of the encounter will be more likely to result in a strong, authentic interaction that is beneficial to both participants.

It is as important for the therapist to benefit from the encounter as it is that the patient benefit. Why do we do psychotherapy? There are many ways to make a living; why have we chosen this one? It must have some important personal meaning. Many therapists have, as a result of their early experiences, taken on a sense of responsibility for others, and are expressing it by trying to help others be happier. Many of us have also suffered emotional injury and are taking this route to try to learn how to overcome it. (Some of us feel more comfortable in the role of helper than as the explicit recipient of help, and may be receiving help vicariously.) It is also a way of expressing compassion for others and a potentially rich and satisfying way to be close to others. And, as with any human encounter, it is an opportunity for both participants to express themselves and relate to each other fully and with vitality.

All of this notwithstanding, most analyses of the therapeutic encounter focus on the experience of the patient. The experience of the therapist is typically considered only as it illuminates the patient's psychodynamics or as it becomes an impediment to the treatment process. We usually do not attend to the therapist's personal involvement in the relationship, but think of the therapist as participating solely as a "professional". That is, the therapist's experience of the relationship is not valued for itself, and the therapist is almost not supposed to get anything personal out of it. It is as if he or she would be "using" the patient if this were to happen. The therapist's sole interest is supposed to be the benefit of the patient.

Such a position is absurd on its face. All it leads us to do is to deny or lose touch with our own experience of the process. We can never have an "impersonal" or "professional" relationship in the sense of not having our own experience of the encounter. To the extent we try to act "professional" we become enigmatic, frightening, defensive, and even traumatizing. One thing we are trying to do in helping our patients is to present a model of a healthy relationship, and if we do not include our own experience as a determinant of our behavior we are not doing so. The patient wants to have a personal relationship with us, and a critical part of our professional relationship with the patient is our ability to consider and value the experience of both participants. To the extent that we consider only our own experience we are narcissistic, and to the extent we consider only the other person's experience we are being self-sacrificing (withdrawn, compliant, co-dependent, co-narcissistic, fearful, defensive). It is not good for the patient for us to interact in these ways, but more to the point, it is not good for the therapist. Such behavior leads to loss of job satisfaction, getting "stale", burnout, loss of creativity, depression. It prevents the therapist from growing and benefiting from the therapy process.

Every patient wants to be able to contribute to the therapist, to be of value. We therefore can be more helpful to our patients if we allow them to give to us, if we are open enough to receive from them. This has to do with personal openness and vulnerability, that we are willing (indeed, hope and expect) to be changed by each patient we work with. It is the belief that each person has something to give us that will be of value to us, which will make us better or richer in some way. Many of our patients have low self-esteem because they were not allowed to contribute to their parents' lives. Their parents did not value them and/or allow themselves to be changed by them, so the patients considered themselves useless or superfluous. It is very helpful for these patients that we let them be of benefit to us. We can only do this by genuinely participating in the relationship in a personal way, so that they then can know who we are, tell how we react, and feel that they are actually in touch with us.

A healthy relationship is one in which each person can both consider and value his or her own experience and the experience of the other person. Considering only one's own experience is narcissism and does not allow for the experience of the other person; considering only the other person's is "co-narcissism," that is, is existing only for the purposes of serving the other. Neither of these modes of interaction allows one to participate in the relationship in a way that has value for oneself.

Therefore, it is orienting for the therapist, and in the interests of both participants in the relationship, for you, the therapist, to make sure you are benefiting personally from your encounter with your patient.



Kathie Dunn MFT, Editor
San Francisco Psychotherapy Research Group, Clinic and Training Center

Phone: 415-561-6771
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