Dear Colleagues,

We just discussed our financial report at the Board meeting today and the good news is that our financial picture is much better than we planned for. We are $2800 in the red for the year after we budgeted for a $24,000 deficit. Our extra income came from Clinic income as well as from some modest fundraising returns. We tend to be conservative in our estimates of what we expect to bring in and that paid off. We are budgeting a small deficit for this coming year but we are being conservative again. We may bring in more money this fiscal year from even greater clinic income and hopefully from fundraising as well as increased membership dues.

We are still expanding our fundraising efforts. We are asking people who can afford it to donate at least $1000 a year. We are also asking members to increase their dues to a minimum of $350 if you can afford it. We are looking forward to expanding our educational programs, pay more for excellent speakers, and reach out to a larger community to come to our conferences. (See my other article in this month's NL). We are also hoping to get APA approval for our Clinic Internship program, but that means we would be obligated by APA rules to pay each intern a small stipend, something we cannot afford at the present time. We are considering expanding the number of interns at our Clinic, but that would require hiring another full time Clinic Administrative Supervisor, also requiring more money.

The Educational Committee is planning new conferences for this year as well as a new post-graduate evening course in San Francisco. The current faculty put on an extremely successful program two years ago in San Francisco and then again last year in Berkeley. I hope those of you who haven't taken the course yet will consider doing so this year. The program is quite intense with excellent discussions of research, theory, clinical applications, and case conference presentations. Read On

The Education Committee is working on developing the schedule of courses for next fall and beginning to plan for the 2012 March Workshop.

A new course is being planned to start in the fall, taught by Larry Hedrick, on the connections between CMT, neuropsychiatry, psychopharmacology, and Schema Therapy. It will be a weekly course, details to follow.

Denny Zeitlin is also scheduled to teach his popular Couples Therapy course, details to follow.

Courses on Supervision, Ethics and other topics are being explored. We are also planning to offer the Post-Graduate Seminar again, in San Francisco this year.

Greetings from the clinic and training center: the training year has come to a close. Over the summer, our interns and postdocs will meet once each month and then resume the weekly training in September.

Although the interns won't be meeting each week, all will continue to see their patients throughout the summer months.

Our intern Scott Arai is leaving the training group this year after two years with us. He has applied to a postdoc program at Princeton but missed this year's deadline. In the interim, he is looking for a psych assistant spot for the next year, so if anyone would like to help Scott continue to see his patients, please get in touch with Jessica or Carol.

Our 2008-2010 intern Ilysa Goldblatt is returning to the clinic this summer to begin her postdoc work. Plus we have two new students from Norway joining us in September. That gives us our largest training group in our history this coming fall with 15 interns and postdocs.

Given our wealth of trainees, we are in need of supervisors. Talk with me, Jessica or Carol if you are interested in working with a trainee this year. It is a wonderful experience for the supervisor and our trainees both.

In closing, everyone's caseloads are mostly full but we can always use referrals, so please keep us in mind. If you have a referral, get in touch with Jessica, Carol or me.

The summer has finally begun! And with this warm weather arrival also look for the arrival of your snail mail SFPRG renewal letter and form coming out July 1st.

An alternative to renewing by snail mail is to go to our website (click below, go to Membership page, follow prompts) and renew online. Per Rob Petitpas, Administrative Director, renewing by check saves us some credit card fees.

We are moving the renewal drive up one month on our calendar each year to mesh more finely with our Education and Fundraising events. If we can answer questions for you about this procedure call or email either Rob (sfprg@sfprg.org) or myself (kathiedunnmft@comcast.net).

The Membership Committee invites you to become part of this important function at SFPRG. Two goals of this committee are to (1) promote membership and (2) serve members. You can help us do an excellent job by sharing your visions to help us move forward in promoting membership in SFPRG and serving an expanding membership base.

If interested, contact kathiedunnmft@comcast.net

Thank you, Kathie Dunn

Research continues, led by John Curtis, George Silberschatz in their 1pm Friday group. Your support will help restore enthusiasm for the research which guided our beginnings and perhaps begin to fund it. John and George are looking to reach publication stage of their Outcome Study by summer's end.

Marshall's 2 pm Friday research group is getting ready to carry out a validation study of the testing concept in a recorded analyses. More participants are needed. Ratings of whether the pt. is testing, what the test is about, and whether the analyst is passing or failing the test are made in the group. Free CE credits are offered for group members. If you want to learn more about and further develop the concept of testing, please attend. Contact Marshall at .

Marshall, with co-author William Meehan, have a paper in The International Journal of Psychoanalysis (see "New Publications" article) which was accepted in October 2010. Congrats!

Another development in Research is a study using Clinic patients and Interns to look at correlations between patient rated attunement and treatment outcome and therapist rated attunement and outcome being conducted by intern John Snyder with George as Advisor.

You are invited to be part of the research at SFPRG, a rich tradition of our group. Contact John Curtis and/or Marshall Bush to get the scoop!

Dear Colleagues,

I am recommending three books. The first two are Marco Iacoboni's Mirroring People (2009), and Anthony Bateman & Peter Fonagy's Mentalization-based Treatment for Borderline Personality Disorder: A Practical Guide (2006). I was very excited to meet and discuss theory with Anthony Bateman in Capetown last November, where we compared and contrasted Control Mastery Theory with Mentalization-based treatment.

I am currently reading David Wallin's Attachment in Psychotherapy (2007), which I'm finding scholarly, well-written, and very stimulating. He outlines the development of Attachment Theory through the work of John Bowlby and colleagues/collaborators Mary Ainsworth, Mary Main, Alan Sroufe, and then Peter Fonagy. I knew that Fonagy's Mentalization-based Treatment was rooted in Attachment Theory but I didn't know until I read Wallin's book that Fonagy had worked with Bowlby in London. Fonagy later did research on transgenerational transmission of attachment patterns and received consultation from Bowlby and Main. I think this line of clinical theory and research is incredibly important and in the mainstream of what is new and exciting in psychodynamic theory and practice. Wallin capably ties in Attachment Theory with recent developments in neuroanatomy and physiology, including a section on the importance of mirror neurons.

As a medical student, I had read Bowlby's book, Separation, and then as a psychiatric resident and child fellow, studied the work of Ainsworth (the Strange Situation) and Main (relating the child's attachment style to parental psychopathology and the parents' own attachment styles). Their groundbreaking research was able to show that infant behavior at 12 months could be identified and categorized in a brief research setting called the "the strange situation" revealing four reliably rated styles of attachment: secure, avoidant, ambivalent, and disorganized attachment styles. Read On

Regarding the first meeting of psychology of the artist series, I would report the following: The first discussion group on the psychology of the artist was held on Friday, June 10. The subject was Paul Gauguin and his art. Attendees were shown a slide show of his paintings and sculpture at the beginning of the class, after which they filled out a brief questionnaire on their reactions to his art. At the end of class, they once again completed the same questionnaire. The results of this little experimented will be reported on in next month's newsletter.

Two guest speakers, Dr. Margaret Hauben and Nancy Ruskin, talked about Gauguin's life and the last place he lived in Polynesia. There were numerous important inconsistencies in the various biographies of Gauguin, who was an unusually complex person and who lived a highly complicated and painful life. What seems clear is that Gauguin directed his passion for art into boldly exploring the expression of emotion through color. His quest for harmony and beauty led him back in time into an imaginary primitive world that was unspoiled by by vices of modern society.

The next meeting, to be held on Fri., July 29, will take up Matisse. Our featured speaker will be Stan Steinberg.

Nonverbal Learning Disabilities in Children: Bridging the Gap Between Science and Practice

Davis, John M., Broitman, Jessica

Although it has yet to be recognized by the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), nonverbal learning disabilities (NVLD) in children are a growing concern. NVLD are receiving increased attention from researchers as well as from clinicians encountering these conditions in their young clients. At the same time, reliable information on effective interventions for NVLD has lagged behind this interest.

Nonverbal Learning Disabilities in Children: Bridging the Gap Between Science and Practice offers a well-rounded understanding of NVLD, placing it within the context of other developmental disorders, most notably high-functioning autism and Asperger's syndrome. The most current genetic, environmental, and neurobiological theories of and research into the causes of NVLD (e.g., the "white matter model"), in-depth diagnostic methods, and quality interventions are examined. Using an evidence-based approach, this groundbreaking volume:

• Conceptualizes NVLD as a disorder with subtypes.
• Differentiates between diagnostic criteria for NVLD and Asperger's Syndrome.
• Analyzes the co-occurrence of NVLD with other developmental disabilities and psychological disorders.
• Provides a comprehensive psychoeducational assessment model.
• Describes efficacious treatments and supports their empirical validation.
• Offers guidelines for sustaining treatment gains through effective collaboration of school personnel and family members.

Jessica Broitman, Ph.D., is the President emeritus of the San Francisco Psychotherapy Research Group and Executive Director of its Clinic and Training Center. She frequently lectures on Weiss's Control Mastery Theory worldwide. Currently a psychoanalyst in private practice since 1980, she has worked with families who have learning disabled children for more than 10 years. She is currently involved in several research projects concerning the treatment and understanding of NVLD, and has a special interest in helping professionals and families understand and treat this disorder.

From the article:

This article presents some quantitative findings from a survey of 89 psychoanalysts (all members of the American Psychoanalytic Association or the International Psychoanalytical Association) about their own experiences in analysis. A comprehensive questionnaire was used to collect retrospective data about (1) how participants felt they benefited from their analyses and (2) how they remembered their analysts' technique, personality, and style of relating. A correlational analysis found that, according to our participants' ratings, the most beneficial analyses were associated with having a caring and emotionally engaged analyst who possessed positive relational and personality qualities, used supportive techniques in addition to classical techniques, and pursued therapeutic as well as analytic goals. Outcomes rated as successful were also associated with experiencing a good 'fit', a good working relationship, and a positive therapeutic alliance. Our results support the call for an expanded view of acceptable analytic technique (e.g. Schacter and Kchele, 2007).

Keywords: history of psychoanalysis, interpretation, psychoanalytic psychotherapy, research, therapeutic alliance

Hello Friends,

At long last, I am a doctor! I graduated from the Wright Institute last week with my Psy.D. after finishing my dissertation on the influence of the military and the CIA on the psychology profession in the U.S.

My research began in 2004 when it was revealed that psychologists had been involved in torture at Guantanamo and my dissertation took on the question: How could this happen? I like the finished product and would be happy to send it to anyone who's interested.

In the meantime, I'm hoping to expand my psych assistantship/private practice and would love it if you could send me referrals. I see clients on Wednesdays and Saturdays in North Berkeley as a psych assistant under the supervision of Molly Sullivan (I need to accrue another 1500 hours before I can sit for my licensing exam and strike out on my own). I am hoping to open up another weekday when I get a few more clients.

I've been treating clients in diverse settings for seven years and in a private practice setting for almost four. I work with adolescents and adults and see both individuals and couples. I enjoy working with high school, college students and twenty-somethings looking to find their way in the world.

Other areas I also work are:

• People struggling with addiction
• New mothers
• Grief and loss
• Mood and anxiety disorders
• Adult children of alcoholics (or other dysfunction)

Email: deborah.kory@gmail.com

In addition we are planning some new social/fund raising events. We have previously announced an art party fundraiser that has been moved to early December, 2011. Let Eric Taggart or Jodi (Reiter) Engstrom know if you would like to share your art with a discerning audience or even sell it on the international market. If you don't have art to make or sell, please come, browse and buy.

We are also planning to begin a tradition of putting on a yearly fundraising dinner that honors important members of SFPRG who have made major contributions either organizationally, through research, or teaching. We would like to acknowledge the efforts and good will of our members who have done so much for our organization. We plan to do this every year for quite some time, starting in early October of this year. Stay tuned to see exactly who, where, and when.

Finally, I would like to highlight a new feature of the newsletter. Susan Landes and John Gibbins from the Education Committee has asked newsletters subscribers and SFPRG members to write about what books they are reading that are interesting, provocative, and worthy of sharing. In that spirit, I wrote another column this month about Attachment Theory, a subject I hope to see discussed in an upcoming conference this year. Please feel free to respond to that article in next month's newsletter and add columns of your own.

The newsletter is a very interesting place to be. It should serve as a forum for us to share what's new, debate what's interesting, and appreciate what's wonderful.

Best wishes for the beginning of summer. I will see you next month.

Steve Foreman

Further studies showed a reliable relationship between the 12 month-old's attachment style and follow-up behavioral evaluations of the same children at age six. Importantly, parents of these children were evaluated using the Adult Attachment Interview (AAI) developed by Main and colleagues. The quality of relationships these parents were capable of could be categorized using the AAI and their parenting styles could be reliably correlated with the attachment styles of their respective children that were shown to be stable from age one to six.

Main noted that securely attached children and their parents were capable of what she called metacognition, that is, thinking about thinking. People with metacognitive abilities were able to distinguish what they felt to be true from what was actually true. In other words, they were able to get some distance from their feelings and convictions, turn them around in their minds, and attain greater flexibility in thinking and feeling. These parents and their children were able to self-scrutinize in a way that allowed them to reflect, to stand both inside and outside their experience. Those children and their parents who were securely attached had greater metacognitive abilities. Those who were not securely attached (either avoidant, ambivalent, or disorganized) had less metacognitive abilities.

Main's concept of metacognitive abilities leads directly to Fonagy's concept of mentalization. Fonagy described mentalizing as the ability to deal with thoughts and feelings in oneself as well as others. Mentalizing is a "reflective function". It is the ability to think about psychology in self and others. Fonagy and colleagues were able to show that parents' state of mind assessed before their child was even born could predict the classification of attachment style in their one year-old as revealed in the Strange Situation setting.

There are important compatible features of attachment theory and Joe Weiss' Control Mastery Theory. The first is the role of safety. Weiss said that the patient had to feel safe to explore and progress in therapy. Bowlby wrote "unless a therapist can enable his patients to feel some measure of security, therapy cannot even begin." Bowlby also stated, "the therapist's role is analogous to that of a mother who provides her child with a secure base from which to explore the world."

Bowlby's concept of "internal working model", the child's expectations of experience and relationships is similar to Weiss' concept of "pathogenic beliefs". Both are cognitive models based on the child's real experiences. Weiss, thought real experience was more important than fantasied expectations. Similarly, while complaining about his supervisor, Melanie Klein, Bowlby said, "I held the view that real-life events - the way parents treat a child - is of key importance in determining development, and Melanie Klein would have none of it ... The notion that internal relationships reflect external relationships was totally missing from her thinking."

Weiss said that the child was fundamentally motivated to "preserve the tie" with the parent. This fits exactly with Attachment Theory's belief in the centrality of the attachment between parent and child. Also, Attachment Theory, Mentalization-based therapy and CMT all share the belief that psychotherapy works by the patient having a transformative experience in the context of a safe, therapeutic relationship where, as Wallin summarized, the patient "comes to know him- or herself in the process of being known by another."

Whereas these research findings about Attachment Theory and Mentalization-based Therapy are compelling and exciting, there are also important differences in the way Control Mastery Theory formulates psychopathology and suggests strategies in psychotherapy. Modern Attachment Theory postulates that insecure attachments lead the child to be unable to regulate affects and thereby fail to develop a healthy sense of self. These postulates are actually very similar to Kohut's formulations and those of Self Psychology that parental empathic failures lead to failure of healthy development of the Self and the child's consequent inability to self-soothe. Modern Attachment Theory places primary importance on the failure to regulate affect as the cause of psychopathology, which derives directly from the child's failure to develop secure attachments. Even though Wallin warns that it may be too simplistic to try to reduce all of psychopathology to four categories of insecure attachments, he seems to do that anyway.

Weiss and Sampson explored the large territory of the role of guilt in psychopathology. Whereas attachment theorists focus on loss and parental empathic failure, Weiss added important dimensions of children's worry about their parents, feelings of being responsible for them, and feelings of tortured guilt and self punishment for causing their parents' pain or failing to resolve it. In explaining psychopathology, Weiss gave great weight to the child's problem feeling too powerful in addition to feeling too weak. Modern Attachment Theory seems to exclude issues of guilt in preference to issues of loss and insecure attachments.

Weiss also described the role of Compliances and Pathological Identifications in understanding how the patient manifests psychopathology. Compliances and Identifications can be seen as elaborate strategies in a child to protect pathological parents at the child's expense. Attachment Theory focuses almost exclusively on parental failures of empathy or connectedness without giving adequate attention to the problematic attempts of the child to protect the parents. Weiss expanded the panoply of parental "traumatic" behaviors to include a wider array of situations in which children feel omnipotent responsibility and guilt.

Another important contribution of Control Mastery Theory is the notion that patients have a Plan. Both Attachment Theory and CMT assume that children are motivated to get better. Weiss described the important observation that patients test therapists in order to get better, a concept completely missing in Attachment Theory and Mentalization-based Treatment. Similarly, only CMT has the concept that patients may turn passive-into active to master previous traumas by identifying with the therapist's capacity not be damaged by the patient traumatizing the therapist in exactly the same way he had been traumatized by the parents. This concept of passive into active can be very orienting in the treatment of disturbed and difficult patients.

In terms of treatment, Control Mastery Theory suggests one's therapeutic strategy should be to help the patient disconfirm specific pathogenic beliefs by taking a specific therapeutic stance or attitude, making interpretations, and passing specific tests the patient poses to help clarify and challenge his pathogenic beliefs. Attachment Theory and Mentalization-based treatment take a more generic approach to being empathic, attuned, and appropriately responsive to help patients become more securely attached so they can develop the capacity to better regulate affects. These other models do not have as varied and case-specific a concept of pathogenic beliefs as does CMT. They miss the concept of the patient testing and the therapist passing tests to help disconfirm pathogenic beliefs.

I met John Bowlby when he spoke at UCSF Grand Rounds during my residency in the early 1980's. I asked him if he thought guilt was an important dynamic in psychotherapy patients. He said it was. I asked him if he thought guilt could be as important or more important than loss. He agreed that it often was.

Ainsworth's Strange Situation was a brilliant way to identify and categorize pathological relationship interactions that were stable over time and Main's breakthrough research showed a powerful relationship between parental style and their child's pathological adaptation. However, I feel it is a mistake to squeeze all of psychopathology into the narrow bin of four pathological attachment styles. Focusing exclusively on the child's failure of attachment misses the importance of the child's misplaced altruism, responsibility and guilt. I also believe that Weiss' contributions of the importance of testing, the notion that patients have plans to disconfirm pathogenic beliefs, the significance of patients turning passive into active in order to identify with the therapist's strength, and the roles of Compliances and Identifications in psychopathology are all significant components of every psychotherapy. Therapists need to be aware of and alert to these developments in psychotherapy in order to better help their patients.

We are hoping to have a conference in the next year presenting Attachment Theory, Mentalization-based Therapy, and Control Mastery Theory. We are hoping to invite David Wallin, a brilliant lecturer and very important Bay Area thinker to participate in a dialogue with our research group. I recommend his book highly to all of you and hope we can continue this dialogue in the coming year.

Steve Foreman