February 14, 2011

Dear Colleagues,

Happy Valentine's Day. We have passed the beginning of the new year and are rapidly approaching March Madness, that is the 24th International Control Mastery Conference. Our educational program will begin on Saturday, March 5 with an Introduction to Control Mastery Theory presented by George Silberschatz.

On Monday morning, March 7, we will greet our guests at 9 to 10 am at #9 Funston Avenue and begin the morning session at 10 am. This year we have an unusually large enrollment of at least 38 participants, with 27 new participants. Because of space constraints, we cannot sit more than 27 people in our conference rooms.

We do not want to cut off enrollment so we are saying that if anyone wants to join the conference at this point, they will have to join the class of returning participants. Also, we will not be able to accommodate more than 27 people in the core seminars at 1 pm each day.

Those who sign up for afternoon seminars will be admitted on a first come, first served basis with preference given to those who have already enrolled for the week. We are very happy to have such an enthusiastic enrollment and we will do our best to accommodate everyone in a comfortable (if cozy) setting. Read On

The Membership Committee has been hard at work finding ways to improve our connection to each other with plans for informal events and a recommendation to our Board for an improved structure for the inclusion of post-SFPRG-interns into membership. After all, these people are the future of our group.

We are hosting a Welcome Luncheon for New Conference Participants on Tuesday, March 8th, 12 noon to one pm in the conference room at #9 Funston. We will provide you with a very nice boxed lunch and limited beverages.

We continue to seek members who are interested in volunteering their time for the Membership Committee. We are a nice group of three and we work well together and with others. New ideas and energies will strengthen our ability to provide members their monies worth.

Our Membership Drive will begin July 1st this year and be concluded by August 15th. While our structure has been more open in the past we have found that a time limited drive works best for our office and committee. We of course welcome suggestions on how to improve our service to you.

I will be present at the Saturday workshop to answer any questions you may have about Membership and I will be at the front door on Monday morning to Welcome you all to our well-organized and bountiful Conference.

Thank you, Kathie Dunn

The Origins of Psychopathology and the Nature of Change in Psychotherapy: A Control-Mastery Theory Perspective

George Silberschatz, Ph.D.

Saturday, March 5, 2011 (9:00am - 4:30pm)

This day-long workshop is based on a series of recent presentations I gave in Switzerland. I focus first on the origins of psychopathology, paying particular attention to early relational experiences and how they are internalized.

Bowlby's attachment theory is an integral part of the presentation. Videos illustrating different attachment styles will be presented and I will discuss Bowlby's concept of internal working models and how they are related to pathogenic beliefs.

I will then show how patients work in psychotherapy to change their internalized relational models through testing, new insights, and corrective relational experiences.

Extensive clinical data as well as results from our recent process-outcome research will be presented. I believe that the workshop will be of interest to both experienced clinicians as well as students and to people familiar with control-mastery theory as well as those who are new to the theory.

Attendance is limited as I will be using audio-video material extensively. Please register in advance at http://www.sfprg.org/continuing_education/courses.html or call Rob at (415) 561-6775. Click the link below.

This month's column profiles Dr. Rachel Rivers, a long time SFPRG member. If you are interested in being profiled in this column, please contact me at maslowj@comcast.net.

Rachel Rivers, D.Min.

My training was in psycho-dynamic, family systems, and humanistic theories, and Swedenborgian theology. Joe Weiss and my uncle, Wickham Skinner, grew up together in Cincinnati and were life long friends, and so when I moved to the Bay Area in 1986, Joe gave me a copy of Harold Sampson's and his newly published book, The Psychoanalytic Process: Theory, Clinical Observation & Empirical Research. I devoured it!

As for many of us, Control Mastery theory struck a deep chord in me and resonated with all of the aspects of my previous clinical understanding that I especially valued. It also provided me with much more: a framework in which I could readily evaluate how effective I was with my patients, and an understanding of how to be even more so. Read On

The clinic has been an exciting place this year. This year we started with 12 trainees from many different places. We had 2 Norwegians in the fall - Biliana and Christina. Unfortunately their placement was only for four months so they had to leave before Christmas, but we gained another Norwegian student in January. Lene will be at the clinic through July. We are expecting two more students form Norway to join us in September. We worked very hard to create a collaboration with Alliant International University whereby they help us with visas. Thank you Dean Morgan Sammons, Ph.D., who graciously helped us facilitate this collaborative process.

We feel very lucky to have the diversity of students from different educational backgrounds, schools and licenses. We are all learning form each other! Read On

I am happy to announce that we are kicking off our Spring Fundraising Drive! Our goal is to raise a total of $15,000. We have raised $6,625 so far this fiscal year though our letter campaign and our first fundraising event.

We are hopeful that with your help we can raise the balance of $ 8375 to meet our goal between now and the end of May. Stay tuned as you will soon receive an email about this important event and details about how you can donate and make a difference.

We will track our progress together in this newsletter over the next few months. I know this organization is important to so many of you. This will be a way to show your support and ensure that SFPRG can continue to serve the community, train new psychotherapists, and further psychotherapy research. Read On

I would like to initiate a newsletter dialogue about testing, one of Weiss's most innovative and controversial concepts. My Friday research group has been studying this concept for the past 3 years. We have entertained a variety of questions about how best to define, operationalize, and measure testing. I think it would further the advancement of CMT to have a lively exchange of views about the nature and importance of testing in various types of therapy and human encounters. I am presenting some initial thoughts about testing for our members and friends to respond to. I know that many of you have written articles about testing and developed your own ideas about this topic.

My own thinking about testing is shaped by Weiss's treatment of the topic in The psychoanalytic process (1986) and How psychotherapy works (1993). I believe that testing, like attachment, serves a vital adaptive function without which people could not survive and science could not progress. I believe that the essential purpose of testing is to discriminate between safe and dangerous situations and between truth and falsehood. Without the capacity to test, one would not know whom to trust or what to believe.

Since testing in psychotherapy (and in all human relationships) is largely unconscious, having access to one's affect signals (which is how we access our unconscious thought processes) and a reasonable capacity for reality testing is essential for being able to plan passable tests and correctly interpret their results. People with limited access to their emotions are impaired in this regard, as are people who cannot question their false assumptions about the world. Very traumatized or discouraged people may not test at all; they just assume the worst. Read On

Dear Marshall:

I was happy to read that you are continuing to design research protocols to further our study of testing. While I differ from many CM therapists in terms of the etiology of Axis I disorders (clinical diagnoses) -I don't think serious psychopathology is derived from childhood trauma, and Joe and I argued about this literally for years-- I'll say a few words about that later-but I continue to believe that testing is the heartbeat of therapy, no matter what the etiology of a disorder.

I currently teach a Professional Development Seminar for third year students at the Wright Institute, and over and over again, I find myself saying to a student who is struggling with a patient -"How do you feel with him/her?" and inevitably, how the student therapist is feeling is a direct reflection of how the patient is testing.

When the student feels overly responsible, that signals that the patient is testing around issues of omnipotence, and I can easily explain to the student "Be relaxed, even though you feel worried that you are not "doing enough" or "helping enough," try not to make that obvious. The patient is looking for a model of how NOT to feel omnipotent when facing others' problems or situations." Read On

I want to thank Dr. Bush for initiating this dialogue about testing, one of the most important and clinically incisive tools that Control Mastery offers to clinicians. I agree with Dr. Bush that therapists differ in their use of the testing concept, maintaining awareness of testing during the course of the therapeutic hour, and levels of consciousness about their own affects and reactions as well as those of the patient as these pertain to tests that may be taking place. Therapists who use the testing concept consciously during the therapeutic hour are aided by intentional tracking of countertransference reactions, awareness and modulation of which can be a key element in facilitating the therapist's ability to pass tests.

For example, a patient demonstrating provocative types of resistant behaviors within the therapy hour can drain the therapist, eventually causing anger and even feelings of dread or aversion to the patient over the course of time. Although it may be difficult for therapists to acknowledge and work with such countertransference feelings towards a patient, it is essential to be able to do so; or the risk is that the therapist may reveal subtle hints of such feelings, which would constitute failing transference tests for patients who may fear being resented, rejected, infantilized, or controlled.

The interaction between patient issues and characteristics and therapist sensitivities and personality characteristics can promote or inhibit the passing of tests. Awareness of and working with countertransference can be a great aid in this enterprise.

I am very happy that Marshall has initiated a forum for us to discuss and critically evaluate key concepts of control-mastery theory. Rigorous evaluations of clinical and theoretical concepts are crucial in strengthening theories and keeping them alive.

Testing is a central concept in control-mastery theory and as Marshall pointed out, may well be Joe's most distinctive contribution to the psychotherapy literature. But it is a concept that needs to be more systematically clarified and operationalized. I've heard control-mastery therapists make statements like "everything the patient does is a test, patients are always testing." If that were true, which I don't believe it is, what use is the concept? Moreover, it is often the case that the same patient behavior can represent different things. Consider, for example, a patient who is chronically late for sessions. In some instances this behavior represents a clear test of the therapist -- e.g., will the therapist notice or care if I am late in the same way that my parents didn't notice or care about me - whereas in other instances the lateness is a characterological or personality trait that doesn't have a primary testing function. Similarly, sometimes when patients behave in a cruel or sadistic fashion towards therapists they are involved in a passive-into-active test but sometimes it may represent some kind of uncontrolled enactment and not a test.

There also seem to be some inherent contradictions in the way we formulate testing. For instance, Marshall pointed out (and I agree with this) that "testing, like attachment, serves a vital adaptive function without which people could not survive". Later on, he notes that "some patients pose tests that are indeed impossible to pass" (which I also agree with). But when I think about it, it just doesn't make sense (in terms of biology, psychology, or evolution) for a test to be vital to our survival and simultaneously impossible to pass. Let me quickly point out that this contradiction is not Marshall's - it's a contradiction embedded in the theory and one that needs to be worked on. I hope that many of you will respond to Marshall's call to roll up our sleeves and get to work on improving a good theory.

Dear Readers,

Lynn and Janice raise important questions about the use of the testing concept in doing therapy. They both note how the therapist's intentional tracking of her countertransference reactions sheds light light on how the patient is testing and assists the therapist in passing the patient's tests.

Janice calls attention to the issue of patient-therapist "match" in dealing with difficult types of tests. Lynn proposes that the etiology of a patient's problems is irrelevant in terms of testing, i.e., a patient's testing may not be based on that patient's life history.

George raises a key conceptual question about testing. Is the idea of a test that is impossible to pass a logical contradiction? What do people think about that?

I hope you will submit your rejoinders to these commentaries on testing.

MB

The Education Committee is pleased to announce that we have had an overwhelming number of registrants for our 24th International Conference in March. As a result of this problem of abundance, seating will be limited at the Conference.

We welcome those of you plan to register late or are planning to come in for only one day or one class, however some core classes for new participants will be closed. Additionally, some of the afternoon core classes will be on a first come first serve basis.

Thank you all for your support of the Conference. We'll see you there. Be on the look out for other education opportunities coming up this year.

In addition to our seminar schedule, we will have Movie night Wednesday night, March 9. We might be able to borrow some of Joe Weiss' paintings to hang at our Presidio home during the conference. Also, we are moving the social night from Friday night back to Thursday night like we used to do when Joe and Estelle Weiss hosted the party.

The Membership Committee is hosting a Welcome Luncheon for New Participants on Tuesday March 8th from 12 to 1pm with a boxed lunch at #9 Funston.

We are hoping that many of our members, teachers, and local people will join us at 10 Funston for the festivities on Thursday night to meet the participants and reconnect with old friends. We are having a large group of Norwegian students and seasoned clinicians coming, so brush up on your Grieg and Ibsen.

We need volunteers to help sign people in, collect course evaluations, set up, and clean up. Please come to seminars, help out, and have fun.

In addition to the 24th International Conference, we are embarking on a spring fundraising drive. We are trying to reach our goal of $15,000 by May. We are planning two new fundraising events for the spring and late summer. Membership dues pay a part of the cost of the organization but we need more support from members and other friends of SFPRG to fund our clinic, our educational program, and our rent at the Presidio.

We would like to hire research assistants as well as expand our clinic to bring in more interns and possibly offer a stipend. Please consider donating time, money, and creativity to make SFPRG and Control Mastery Theory a bigger fixture on the landscape of the current world of psychotherapy. We are greatly appreciated by our local community and by surprising enclaves of enthusiastic students and practitioners around the United States, in Europe, South America, Asia, and now South Africa. Please join us to help enlarge the theory, challenge it, make it more relevant, and more accessible.

I hope to see you in the next month.

Steve Foreman

I mentioned that we held our first fundraising event-- a stunning jazz piano performance by Denny Zeitlin at Steve Foreman's home. This was such a lovely event and a rare opportunity to see Denny perform in such an intimate setting. Thank you again Denny for your generosity and your dazzling performance.

We are planning at least two more special events this year. We are creating unique and relevant events that we hope you will find worthwhile, meaningful and fun. Stay tuned as we will announce the details of our next event very soon.

I want to extend a heartfelt thank you to everyone who has already offered support, either directly through a donation, or by volunteering your time or skills in some way. Your contributions are deeply appreciated. You really have made a difference.

I conveyed my enthusiasm to Joe, and he promptly not only invited me to join his weekly case conference, but also asked me to be one of the two presenters for the year. Wow! How thrilling to a young clinician! How daunting! And what a tremendous introduction and full immersion into Control Mastery theory. In the intervening twenty-five years, my respect and enthusiasm for the theory and its direct application to clinical practice has not diminished, but increased.

As well as being a psychotherapist, I am also an ordained minister. I was pastor of the San Francisco Swedenborgian Church from 1990 to 2008. I left parish ministry two and a half years ago to return to full time counseling, along with teaching seminars on spirituality, and occasionally officiating at weddings and other rites of passage. I have a practice in San Francisco, as well as in my hometown of Inverness, on the Point Reyes peninsula, where I love to hike the hills and kayak and swim in Tomales Bay. I work with individuals, couples and families facing any number of life challenges. I specialize in premarital counseling, difficult transitions, anxiety, grief, and the search for meaning and purpose. I am an SFPRG Board member, with a strong desire for Control Mastery theory to become more well known in the therapeutic community.

I am presently taking new referrals at both my San Francisco and West Marin offices, and can be reached at: 415-669-9896.

Just as we are beginning to get comfortable, Jessica and I are starting to plan for next year's group. We find ourselves in a unique position with many of the trainees staying for post doctoral training. It is wonderful to have them however it means we will not be able ( due to space limitations) to take more than a few new interns. The deadline for applications is approaching so if you know of any possible exceptional trainee, please have them contact Jessica ASAP. Please let them know that we require a two year commitment.

We would like the community to meet our intern group so we have asked them to introduce themselves. In this issue of the newsletter we will be introducing 3 of them - 2 of our post-docs and one pre-doctoral intern.

John Snyder is a post-doctoral intern who is also the Research Coordinator at the training clinic and has recently begun a new research project (in collaboration with John Curtis) involving all interns and their patients. John received his PsyD from Pacific University, Oregon, in August 2010. He attended the University of Washington for his undergraduate studies. His dissertation was titled: Examining the Relationship Between in-session client and Therapist Experiences. His specialties include men's issues, trauma and abuse; sexuality and multicultural issues.

Bob Nemerovski is another of our postdoctoral trainees. He earned his doctorate in Clinical Psychology from the Wright Institute, where his dissertation on "Road Rage" found evidence for relationships between trait driving anger, cognitive biases, and failures in cognitive empathy. Patsy Wood was Bob's dissertation chair and also introduced him to Control Mastery Theory. Bob's clinical interests and experience include helping clients with anger, chronic anxiety, trauma, self-image struggles, and repetitive interpersonal problems.

Reeta Hernes is completing her 4th and final year in the PsyD program at John F. Kennedy University in the East Bay. This is her first year of pre-doctoral internship here at the clinic and she finds it refreshing being surrounded by others who hold Control Mastery theory as near and dear as she does. At this point in her young career, her developing level of expertise is in Queer issues and sexual trauma. She is in the mist of collecting data for her dissertation titled "The Impact of Sexual Abuse on Lesbian Sexual Identity".

Once again, let us thank you one and all for helping us make the clinic what it is. We would not be able to exist without your help and referrals. If you have questions, would like to teach or supervise, please contact me. Carol Drucker.

We know that testing in therapy serves a variety of functions and takes many shapes and forms. Patients test to find out how trustworthy the therapist is, how safe they will be to remember and discuss painful experiences, whether the therapist will repeat their parents' traumatizing behaviors and confirm or disconfirm their pathogenic beliefs, whether the therapist will model better ways of coping with traumas they found overwhelming, and whether the therapist will provide the corrective emotional experiences needed to master childhood traumas.

I believe that therapists differ widely in the extent to which they actively use the testing concept in the way they participate in the therapeutic exchange, process the patient's material, emotionally respond to the patient's feelings, and formulate interventions. Some therapists only think about testing when an unexpected problem arises or when reflecting back over a session. Some therapists have observed a decline in testing over time. There are diverse opinions about how, when, and whether to interpret a patient's testing behavior.

Therapists also differ in their ability to understand and tolerate different kinds of tests, especially passive into active tests. Therapists who are sensitive to rejection or prone to feel overly responsible for their patients, may find certain tests hard to endure or impossible to pass. And some patients pose tests that are indeed impossible to pass. Many patients engage in disturbing passive into active behaviors that are not tests at all but rather serve vital defensive functions. The testing concept can also be misapplied to the therapist's and the patient's disadvantage.

There are many theoretical questions that remain to be explored. How is the ability to unconsciously test related to such things as

(1) one's capacity for mutuality?

(2) the ability to intersubjectively understand others?

(3) the nature and quality of one's attachments?

Do patients differ in their need to test? If so, how should this be understood? Do patients differ in their ability to generalize from the experience of having important tests passed? Do children and adults test differently? These are of few of the issues that are worthy of dialogue, debate, and discussion.

Please send your commentaries, however brief, both to the editor of the newsletter, Kathie Dunn (kathiedunnmft@comcast.net), and to me at (drmbush@pacbell.net). I look forward to a lively exchange of ideas. Marshall Bush

Although some of my students were in two-year long Case Conferences with CM teachers/clinicians, they continue to have difficulty capturing this lesson -how they are feeling is a signal of how the patient is testing. Despite the fact that the Wright Institute is ostensibly a "psychodynamic" program, with much talk about the "unconscious," it is difficult for students to fully realize how much going on with patients involves unconscious testing, and I should add, how much unconscious responding on the part of the therapist. In fact this may be the most difficult thing for students to really believe in. They worry about their "counter-transference" as if it is merely a reflection of their own "childhood problems" instead of welcoming it as a road map of where the patient is going.

All of our patients test us, like all of our children and grandchildren test us. The etiology of their problems is irrelevant in terms of testing. We may not know why they have whatever difficulties or frank psychopathology they suffer from, but we can learn how to help them simply by using our own reactions, and then as you mention, paying close attention to their reactions to our interventions.

I want to say just a few words about the issue of etiology, and why testing may not be based on a patient's particular background. First, throughout history, the treatment of children has varied. For hundreds of years parents believed, "spare the rod, spoil the child." We might think that was childhood trauma, and yet most children grew up without serious mental disorders. Children from the same family may grow up entirely different from one another, even if the parents were basically the same with all of them. Inborn temperament, exposure to viruses or bacteria at the "wrong" time in a pregnancy or early childhood, exposure to combinations of neurotoxins in our contemporary world, genetic makeup inherited from one or both parents or grandparents, all may contribute to etiology.

Despite the wide variation in terms of causal factors in patients' problems, patients test us, and we can figure out how and what to do about it, how to respond, simply by paying attention to how we are feeling. This is a very hard thing to get across to our students in training, and I am not sure why. Perhaps it's because in most theoretical perspectives (including psychodynamic, Kleinian, intersubjective, self-psychology or cognitive behavioral) differing from our own view point, they fail to understand that almost all patients are really organized, planful and in most cases, nonconsciously altruistic.

My objection to self-psychology and all its offshoots is and has been the idea that patients have "deficiencies," developmental holes in their psyche. Whatever their problems may be, they are not lacking in psychic structure. Their biology may be off, they may have neuropsychological diseases, their social circumstances may be disruptive or dismal, but they are not lacking in psychic structures. Yes they need and want a corrective emotional experience, but not to fill in something that's missing. They want us to model something different, and this is very subtle. They want us to be like teachers, mentors, and yes, like good parents who know a whole lot about the bio/psycho/social nature of people and their problems. And for optimal learning, they guide us by testing.

A patient may have had wonderful parents but have an Axis I mental disorder, and the parents were not trained to be bio/psycho/social experts. We have to be, in order to be the teachers our patients are seeking. With this perspective, no matter what the original problem or its source, we do best when we are cognizant of how our patients are testing.

So I am really glad you are continuing on with this line of research, a deep understanding of testing is perhaps the hardest thing for our students to learn, and yet the most important component of what we have to offer.

Note: I have a chapter coming out in a book on Pathological Altruism, in press, Oxford U. Press. I think you will like it, I'll get a copy to you directly and also to the office.