Dear Colleagues,

Thank you to all of you who attended last month's conference with David Wallin and myself featuring a Dialogue between Attachment and Control Mastery Theories. It was a very successful day, with over 100 people registering. Attendees came from as far away as Portland, Sacramento, and Los Angeles, bringing along students and colleagues. This was our second large successful conference of the year. In June, Louis Breger, George Silberschatz, and Suzanne Gassner presented a highly-regarded seminar on Outcome with almost one hundred attendees. The Education Committee is experimenting by bringing in major writers and thinkers who are expert in subjects that are compatible with but different from Control Mastery Theory.

In the Spring, SFPRG will present another major conference on a subject that we have never presented before - Post Traumatic Stress Disorder. Our guest speaker will be Victoria Beckner, author of two books on PTSD and a prominent member of the PTSD treatment center at the San Francisco Veterans Administration. She has a theory about the centrality of Exposure Therapy in all psychotherapy, but especially with traumatized patients. She will be joined by Susan Landes and Ginger Rhodes, two experts on trauma from SFPRG. We hope to get a large turnout again from our group membership as well as from those in the community interested in trauma. Our idea is to introduce Victoria's perspective to those less familiar with Trauma and we hope to expose those in the audience to Control Mastery who have less familiarity with our theory.

Denny Zeitlin will present his wonderful conference on Couple Therapy on November 17. I hope many of you have a chance to hear Denny's clear and very thoughtful presentation of Control Mastery Theory and its special application to work with couples.

The other major event that is coming up soon will be the SFPRG Fundraiser Art Party, Auction, and Reception at 9 and 10 Funston on Saturday, December 1 from 4 to 7 pm. The auction will take place from 6 to7 pm, led by auctioneer extraordinaire, Judith May. Works of 14 artists will be on display, including new prominent Bay Area artists not exhibited at SFPRG before. The auction will feature the sale of another painting by Joe Weiss donated by his generous family as well as many other paintings. In addition to being a fundraiser and a lot of fun, the art show offers us the opportunity to show off our Clinic and offices to those in the community who may not be familiar with SFPRG. Bring your friends, your families, and your art-loving compatriots. Last year's Art Party was one of the highlights of the year and I think it will be another spectacular event this year.

I hope you have a wonderful Thanksgiving. See you next month.

Steve Foreman

It has been a busy time at the clinic. The new group of trainees has begun to settle into the clinic routines and the returning group is helping them get settled. This year we started with a total of 15 trainees, although John Snyder, Ph.D. has recently obtained his psychologist license and will leaving the clinic as a post-doc., but continuing with the clinic in the role of research coordinator. John is currently working on research following therapist-client attunement and has the trainees and their patients tracking their ideas about patient-client attunement every week. He has begun to present his work at different conferences.

We have a full schedule of trainings planned for this year. The topics that have been presented at this point have ranged from following real clinical hours with Alan Rapaport; learning about supervision with Lynn O'Connor; working with people who have been victim of sexual assault with Natalie Porter, schema therapy with Larry Hedrick, and working with clients with Jane Weisbin. During the fall we had a special 4 week course given by Bridget Walker on CBT. We are hoping to bring outside people into our educational program to expose our trainees to as many different ideas as possible. Jessica and I think that having a range of theoretical ideas and understandings help make the trainees stronger and more versatile as clinicians. We will continue to have many more trainings and are very excited about the variety of people who have agreed to teach.

During the summer Camerin Ross and Amy Friedman ran a group where they taught basic interpersonal skills. They are each branching out to create 2 new groups. Amy is working on a parenting group with Laura Condylis and Camerin with the help of Joy Phillips is putting together a group focusing on Mind over Matter. Jessica and I are pleased that they are adding groups to the clinic.

Thanks again for all your support in teaching and supervising. Your help is part of what makes the clinic such a special place.

Carol Drucker, Ph.D., Clinical Director

Our Art Show, Auction & Reception is Saturday, December 1, 2012 from 4pm - 7pm. The Weiss family has generously donated another painting by Joe Weiss that we will auction off that evening around 6pm. Last year's show was well attended by people who enjoyed viewing paintings, sculptures, jewelry, and photography by SFPRG members and friends while enjoying wine and hors d'oeurves. The lively and fun auction of several works of art brought in significant donations to SFPRG. Judith May will once again be our auctioneer. Please bring your family and friends to the event to support SFPRG and have a good time with your colleagues. Art will be displayed in both of our buildings in The Presidio at 9 & 10 Funston Avenue. Hope to see you there!

To see a photo of the Weiss painting to be auctioned click the link below or go to our website: http://sfprg.org/Art_Show_2012.html

Also, Giclée prints of Gay Galleher's Wine Country Reverie are available now. Please contact the office.

The Next Generation: Thoughts on Control Mastery Theory and Therapeutic Assessment by Vanessa Cirulli, M. A.

As a doctoral student on the edge of launching my career in clinical psychology, it has been exciting to try on varying approaches and interventions as I explore what therapeutic language best suits me, and in turn best benefits the clients I serve.

This past year I had the great fortune of discovering Control Mastery theory at the suggestion of my advisor, Dr. Alette Coble-Temple, at John F. Kennedy University. At the time, I was also at a clinical practicum where my main responsibility was to administer psychological assessments to adolescents in foster care or otherwise involved with the child and family services system.

I wasn't then aware of the long history of the dichotomization of assessment and therapy in psychology, but what became quite clear as I began working with my clients, was that I was not the "white coat" assessment type. I couldn't sit in a room with traumatized young women, for example, and extract just enough information to answer a referral question, and then go to my office to analyze some data, write a report, and hand it all over to a social worker. I could not imagine interacting with my clients or the many people in their systems and not be of more therapeutic service.

And so rather by accident-and then with my supervisors' support and encouragement-I began conducting Therapeutic Assessments, a theory and technique pioneered by Stephen Finn, PhD, that integrates psychological assessment with psychotherapy. Finn believes that psychological assessment is an "interpersonal event" that has the potential to impact a client, ideally for the better (Finn, 2007, p. 21). He advocates for assessment intervention sessions with clients and their many systems of people throughout the testing process in order to use the test data to begin ushering in a "new story" (Finn, 2007, p.14) about the client. The main goal of Therapeutic Assessment, Finn (2007) says, is to "help clients develop new, more accurate and useful understandings of themselves and the world" (p. 235).

What I began to see happening, is that Finn's intentions for psychological assessment, Sampson and Weiss' goals for Control Mastery theory, and my work with highly traumatized young women were an elegant fit. Read On

The conference on The Curative Element in Psychotherapy: A Dialogue Between Attachment Theory and Control Mastery Theory, with David Wallin and Steve Foreman, was one of the best conferences I have attended through SFPRG. It was an in-depth conversation and mutual exploration, with good will and respect between the two presenters. They each spoke for an hour and a half at the morning session. In the afternoon each presented cases followed by further discussion. Both gave equally engaging and thorough presentations.

To summarize the conference: Attachment Theory presents the healing or curative process as a function of a secure psychotherapeutic attachment that replaces the effects of an insecure or disorganized childhood attachment. Control Mastery Theory similarly presents the curative process as a function of a secure psychotherapeutic relationship, but also includes using the principle of adaptation to understand patient experience, allowing the therapist to infer pathogenic beliefs, pass tests, and make pro-plan interventions.

David Wallin began with the disclosure that he felt uncomfortable with the format of the conference. He is more used to expanding his talk into the full six-hour time frame and felt rather constricted by the limitation of an hour and a half for his overview of Attachment Theory. "I like to free associate," he explained. Having said this, he pulled up a PowerPoint presentation that rolled through the major contributors to Attachment Theory, from John Bowlby through Mary Main, and offered a clear explanation of the developmental process as a function of human bonding.

His initial self-disclosure on the format of the conference set the stage for a very personal talk. David used case examples from his practice and shared his own quite intimate thoughts, feelings, and responses to patient process in these examples. He was very engaging, and the audience could see how he was likely to be in session with a patient.

The main idea of his presentation was based on John Bowlby's theory, quite radical at the time, of the lasting influence of early attachment styles on the development of the individual. These attachment styles are initiated in the relationship between infant and parent/caregiver, and form the basis of all later interpersonal relating. Read On

Having been immersed for many years in Control Mastery Theory (CMT) and more recently with attachment based therapies (EFT and AEDP), it was a stimulating and integrative experience to attend the CMT/Attachment theory conference with Steve Foreman and David Wallin. In my comments, I will briefly summarize and elaborate Steve's useful discussion of both the overlap between the theories and the unique aspects of CMT. Finally, I will comment on how some of the unique aspects of Attachment Theory, as discussed by Wallin, might further animate and complement CMT. Those of you already familiar with Steve's view of the similarities and differences in these two theories might choose to skip the initial discussion.

-Both theories prioritize the role of relational safety with the therapist in creating new and healing experience

-CMT's construct of unconscious beliefs overlaps with the attachment construct of Internal Working Models (secure, insecure, disorganized attachment) . Each of these constructs represents the individual's internalized view about reality, self and other and can lead either to preferred and healthy development or, in the case of pathogenic beliefs and insecure/disorganized attachment, to psychopathology.

-Both theories prioritize real experience in the development of working models/pathogenic beliefs. Most of us are familiar with how this works in CMT through the child's compliances and identification with problematic caretaking. Wallin traced a similar path in attachment theory by discussing how the infant must adapt to the real strengths and vulnerabilities of the attachment figure, developing the particular internal working model according to these reality based assessments.

-Both theories prioritize the need for the child to become strongly attached to the parent for physical and emotional survival. Because of this survival based attachment, both theories argue that the inner strivings of the infant (feelings, needs, goals) and related behaviors that evoke the anxiety/rage/disinterest of the attachment figure must be defensively excluded/repressed until a safe and new healing relationship with an important attachment figure/ therapist allows the individual to integrate and express previously repressed or dissociated experience.

- Change in both models of therapy occurs primarily through a new transformative experience with the therapist, which might include insight/interpretation (CMT) or "mentalizing" in attachment theory (thinking about thinking) as a more reflective aspect of the new experience; in this healing relationship pathogenic beliefs are overcome (CMT) and the client develops "earned security" of attachment.

Steve further and eloquently elaborated what's unique about CMT and persuasively applied these understandings (the importance of unconscious guilt, compliances, identifications, the unconscious plan, the role of transference and passive-into-active testing) to both his own case material and in responding to David's cases. Read On

Reflections on the Attachment Theory & Control Mastery Theory Conference

October 27, 2012

David Wallin, Ph.D. & Steven Foreman, M.D.

The conference which drew a large attendance began with David Wallin giving a power point presentation on Attachment Theory followed by Steve Foreman's power point on CMT. Then Wallin presented a case after which Foreman commented on similarities in CMT treatment. Foreman presented a case and Wallin made comments regarding Attachment Theory and so it went for several other cases. Audience questions and comments were addressed by both Wallin and Foreman.

CMT has a more exacting explanatory power based because of its understanding of the patient's plan, and how the patient tests through transference and passive into active. Wallin posed a question as to how to understand cases which have gone extremely well at least in the view of the therapist only to "blow up" in his words with the patient bolting from treatment. From a CMT perspective, there could be several explanations. We would have to know the history of such a patient to make a more specific analysis. One possibility might be as one CMT member noted about her own case, that this was a rejection test perhaps with the patient believing that it would not be fair to make even greater progress. Another responded that a patient may have in prioritizing her plan needed to test the therapist on lower threshhold tests before feeling emboldened to present a more difficult test. A non-CMT therapist may incorrectly believe that the shift in the patient was due to an error in treatment when the opposite may be true; i.e., having passed earlier tests, the patient felt safer to test on more critical pathogenic beliefs. It could also be possible that a patient may have achieved her goals, but felt too guilty to end the therapy, so she had to devalue it and/or the therapist so she can leave. So, too, the patient could be turning passive into active by rejecting the therapist; e.g., if the patient's parent had suddenly withdrawn from or devalued the patient breaching what had been a close and intimate relationship. Of course it could have been due to the therapist's error, but the value of CMT is that it allows the therapist to examine any of these possibilities.

Attachment Theory shares with CMT the importance of a corrective emotional experience although CMT allows us to a more specific understanding of its usefulness to patients due to the plan concept. I believe that a corrective emotional experience may be mutual for both patient and therapist. As I gain more trust in myself seeing how it positively affects the patient, the I bolder I become in valuing what I have to offer. The patient not only benefits from my reacting differently from how her beliefs dictate, but experiences me as someone who trusts himself thereby acting as a different model for her to emulate and so come to trust herself more. Attunement also plays a major part of both theories as it does with other relational theories. Indeed, I believe we could call our work Control Mastery Attunement Theory in that we can intervene with an infinite variety of responses based on our individual styles and techniques and have our patients make similar progress. Attunement encompasses what Hal Sampson has referred to as the importance of treatment by attitude. Other relational theories also may be more accurately described as attunement theories.

Wallin stated that we know others most deeply on the basis of what we know about ourselves. Our ability to know others will be limited by what we are unable or unwilling to know about ourselves. As a member our Wednesday Seminar so perceptively noted when we discussed the conference there, we know ourselves by knowing the other. Wallin put emphasis on the therapist's need to mentalize and engage in mindfulness as well as encourage that in his patients. I find that trusting myself in the session works best for me, and afterwards writing my notes I make more sense of what happened and why. Sometimes it takes a lot longer to understand than that--even years.

The audience was enthusiastic with many saying it was the best conference they ever attended. They appreciated Wallin's willingness to expose his deep feelings regarding his work with patients. Foreman's respectfulness of Wallin's work and Wallin's of Foreman's created a safe place to explore commonalities and differences in our work. A number of SFPRG seminar leaders and supervisors as well as other senior CMT clinicians I spoke with during the intermission and lunch were unanimous in their appraisal of the high level of discourse there. It confirmed for many the advantage CMT has over other relational theories in treating patients. To be sure, Attachment Theory has important contributions to treating patients. After reading Wallin's book earlier this year, I found myself integrating some of those concepts into patient treatment in a more conscious way. The accent on the importance of mirroring is particularly useful as my patient's confirm as they do the concept of mindfulness. We may have different terms to describe what we do. Whatever language of therapy we use, patients will respond positively when we are attuned to their conscious and unconscious plans. This perspective will allow us as clinicians of different theories and techniques as well as personalities to acknowledge our similarities rather than focus on our apparent differences so that our patients may benefit.

Norman M. Sohn, Ph.D.

Anxiety, depression, anger, guilt, and shame are all common feelings that hold many of us back. SFPRG is now offering a group for those of us who struggle with these strong feelings. This group will provide a safe setting from which to explore and better understand the way these feelings are affecting our daily thoughts, moods and actions. As better understanding of these connections emerge, the group will learn CBT strategies to help our mind gain improved control over our moods.

-The group will meet on Thursday's for 12 weeks from 12:00-1:30 PM beginning December 6th

-Cost of the group is $10/ session for current SFPRG clients and $15/session for all other participants

-The group is a closed group. Please call 415-857-0913 to schedule an intake interview.

Camerin is a second-year predoctoral intern from the PhD program at CSPP. Her clinical interests include intuitive eating and body satisfaction, addiction and recovery, and life transitions. She is currently entrenched in her dissertation, an evaluation of a 16-week psychoeducational group for eating disorders at Beyond Hunger Inc. program in San Rafael. Camerin enjoys learning and sharing resources with colleagues as well as tennis, travel and creative arts.

Joy graduated from the Wright Institute in 2010 with an MA in Counseling Psychology. She is currently earning her MFT license hours working at Cesar Chavez Elementary School and SFPRG. Joy particularly enjoys working with elementary and early adolescent age children and their families, young adults experiencing the "quarter-life" crisis, and women in transition. She enjoys running, baking, yoga, and playing competitive volleyball around the Bay Area.

Develop a framework for better understanding your feelings as a parent, your behavior and your interactions involving your children within a facilitated, emotionally protected environment. Learn about yourself and others' experiences and challenges as a parent through a participatory group process.

Within the safety of a private and confidential group setting of parents and trained facilitators, group participants will begin to open doors to parenting in ways that better nurture the parent-child relationship.

For whom: Parents

Dates: January 8-March 19, 2013 (10 sessions)

Day and time: Tuesdays, 10:30-noon

Location: SFPRG in the SF Presidio

Fee: $150 ($100 for current SFPRG clients)

Application process: Please call (415)677-7946 - ext. 6 for Laura Condylis, or ext. 3 for Amy Friedman for information and/or to schedule a required intake interview

Facilitators: Laura Condylis, Psy.D PSB #37184, has a Doctorate in Clinical Psychology. She has one young child.

Amy Friedman, MFTI #61939, has a Masters in Counseling Psychology; and an MBA. She has two teen children.

SFPRG Training Clinic is the premier training facility for Control Mastery Theory (CMT). CMT encourages patient-therapist collaboration to meet the goals of the patients. Ongoing research remains core to SFPRG and its clinicians who strive to understand and perfect what is most therapeutically beneficial to individual clients. For more information, please see: http://sfprg.org/low_fee_clinic.html

A 16-year-old female client, R, had been referred to psychological assessment as a "last resort." Currently in foster care, she had endured a lifetime of neglect and was reacting in ways that the many people in her many systems could neither understand nor tolerate. She had been ascribed inaccurate and compassionless labels (Finn, 2007) such as "manipulative," "drama queen," and "oppositional" and as a result, had developed many beliefs of inherent "badness" about herself.

Control Mastery, which assumes that a client's problems derive from unconscious pathogenic beliefs developed from responses to early traumatic experiences, gave me the language with which I could begin helping R reframe these beliefs about herself.

When R asked me, "Why am I so emotional?" during our first clinical interview, the lens of Control Mastery helped me hypothesize early on in the assessment process, that R not only had an unconscious plan to be able to regulate her emotions and possibly stay out of trouble and succeed, but that she may also be looking for my help disproving the beliefs that she is "manipulative" and "oppositional." In fact, knowing we were going to be doing a number of tests to help us understand her better, she wanted evidence.

Finn's empathic and collaborative model of assessment paired with the Control Mastery framework sets the stage for less pathologizing and more pro-plan data analysis and intervention. R's elevations in anxiety and trauma throughout her testing combined with her high Engagement and Cognitive Processing Rorschach scores, for example, helped me explain to her and her caregivers how hyper-vigilance can lead to information overload in one part of the brain and under-functioning in the part of the brain that regulates emotion. I used themes from our interviews and other projective and personality tests to then make interpretations about how R currently resolves painful feelings and how her childhood experiences primed her for these reactions. Having considerably less time with her than I would a traditional therapy client, the idea was to use testing to provide R with options and to give her the space to begin considering alternative interpretations of her behaviors and beliefs about herself.

I believe one of the many gifts of Control Mastery to assessment is the theory's follow-through. If, throughout assessment testing, we are paying attention to not just the "Referral Question," but to the client's pathogenic beliefs and unconscious plans, then our "Recommendations" section of the final report is going to be an accurate description of pro-plan interventions. Or, in the immortal words of R after reading my recommendations for her: "Duh. That's what I told them."

In Steve Foreman's September report he quoted Hal Sampson: "You don't want Control Mastery to be a museum piece You want it to be a living thing it's only going to live if the next generation infuses it with new vitality "

I hope this is one way my generation can continue to keep Control Mastery alive.

References

Finn, S. E. (2007). In our clients' shoes: Theory and techniques of therapeutic assessment. New York: Psychology Press.

Vanessa Cirulli is a clinical psychology student in the doctoral program at John F. Kennedy University in northern California. She is currently conducting Therapeutic Assessments with children and their caregivers who are served by the bureau of Children and Family Services (CFS). She can be reached at v.a.cirulli@gmail.com.

The role of the psychotherapist, according to David, is to form an attachment that mimics a healthy parent/child relationship. He likened the process of psychotherapy - the relationship between the therapist and patient - to the attachment between parent and infant. In this way the curative element in psychotherapy is in the formation of a healthy attachment with the psychotherapist.

David's therapeutic style, like his presentation style, relies heavily on attention to countertransference and the use of self-disclosure. In line with this, and going a step further with the analogy of infant-parent attachment as a model for the therapeutic relationship, he talked about the importance of the therapist's flexibility and responsiveness to the patient's affective states as essential to the establishment of a healing attachment in the therapy. He also made the point that the therapist has to change, or shift her or his personal ground with respect to the patient, for the patient to be able to change.

The liberal use self-disclosure in psychotherapy can be helpful to some patients, but it was clear that it didn't necessarily work for everyone. David gave an example of a therapy that started out "beautifully" and felt to him like he and the patient were relating very well, until about six months into treatment. Then the therapy "blew up." The patient inexplicably wanted to quit, and in spite of David's efforts to reengage with him, he left treatment. This was not so much an admission of failure (although he presented this as a failed therapy) as it seemed to be a statement of the innate limitation of attachment therapy. Since success in psychotherapy depends on a "successful" attachment or a "good interpersonal match," some psychotherapist/patient matches just don't work out, just like life.

Steve Forman also began with a history of Attachment Theory, and used the example of a suckling infant to compare Bowlby's ideas on maternal-infant bonding with those of Freud. Suffice it to say that Bowlby's theories of attachment behavior are far more useful and more humanistic than Freud's, and much more compatible with Control Mastery Theory.

Regarding the question of what the curative element in psychotherapy is, Steve noted that while Attachment Theory emphasizes the importance of improving the capacity for affect regulation, Control Mastery Theory emphasizes the role of relinquishing pathogenic beliefs. Both theories rely heavily on the importance of safety in the therapeutic relationship, but differ in the focus of the therapy process.

Starting with the name Control Mastery (the patient asserts unconscious Control over when to lift repressions and bring unconscious material to consciousness, and is fundamentally motivated to Master problems and overcome difficulties), Steve presented Joe Weiss' theory in the tradition of other humanistic theorists. Children innately strive to grow and develop, and do so in the context of the important interpersonal relationships in their lives, especially their parents. In the course of the natural developmental strivings, they may encounter traumatic experiences that discourage or derail them. The way the child understands these experiences affects the way the child sees herself or himself and the world. These internalized conclusions about self and others that are drawn from traumatic experiences are called Pathogenic Beliefs. Pathogenic Beliefs are the source of developmental difficulties and may generate symptoms such as depression, anxiety, inhibitions, troubled relationships, or disturbed behavior that can last long into adulthood.

Children protect their parents by feeling responsible for family problems, even if the problems were not directly the fault of the parents. Children accomplish this with the use of Compliance and Pathogenic Identifications. Compliance is the child acting as if an inaccurate and damaging parental attitude were true, and Pathological Identification is the child imitating the inappropriate behavior of the parent(s).

Patients naturally strive in life to overcome obstacles to success, and they work in therapy to disconfirm Pathogenic Beliefs. To accomplish this, patients utilize a personal strategy, or "plan," that reflects the specific nature of their problems. The goal of the therapist is to become an ally to the patient with regard to this plan so that both the therapist and the patient are working together to help the patient overcome pathogenic beliefs and achieve her/his goals.

According to Control Mastery Theory, it is in this process of behaving or acting in therapy as if the pathogenic belief were true that the patient "tests" the therapist to see if this is the case. As the therapist gets better and better at identifying and passing tests, the patient feels safer and the patient brings forth new information that lets the therapist know that the tests are being passed, and the therapy progresses.

Control Mastery Theory identifies two specific ways that patients test the therapist: Transference Test and Passive Into Active Test. The Transference Test is an enactment that places the therapist in the role of the parent, and the patient in the role of the child. To pass the test, the therapist does not repeat what the parent did to the child, thus giving rise to a very different feeling in the patient than the patient is used to getting under these circumstances. The patient will often feel relief when this happens.

With Passive Into Active Tests, the patient takes the role of the offending parent and does to the therapist what was done to her or him as a child. In this case, the patient wants to see how the therapist handles the trauma that the patient experienced as a child. As long as the therapist can handle the traumatic situation in a way that is an improvement over how the patient was forced to handle it as a child, the therapist will pass the test.

What these two theories have in common is that psychopathology is rooted in early childhood trauma, and that the therapeutic relationship is one that imparts a specific kind of emotional safety that allows the patient to address and overcome the effects of early childhood trauma. Both have a language describing the development of pathology that occurs with ruptures or traumas in the primary interpersonal bonding experience.

However, unlike Attachment Theory, Control Mastery Theory uses a language of adaptation to present these traumatic childhood situations in a way that allows the therapist to infer the manner of treatment that will allow the patient to feel safe and make advances in therapy.

I add here some thoughts about two emphases within Attachment theory that could potentially enrich a CMT based therapy. These include the concepts of disruption/repair and a highlighting of preverbal and bodily based experience.

Despite our best efforts to facilitate earned security of attachment through a new and healing relationship, Wallin and other attachment theorists remind us that we are no less human than our clients; the client's attachment vulnerabilities (or pathogenic beliefs) not uncommonly trigger our own attachment vulnerabilities/pathogenic beliefs in a dynamic pattern of enactments within the therapy relationship. In an extremely helpful way, CMT views such enactments from the clients' perspective through the concept of unconscious testing and helps us to consider that the client is communicating something important about their pathogenic beliefs/attachment vulnerabilities and hoping that we will respond differently to these enactments/tests than the traumatizing other or traumatized self. In Weiss' How Psychotherapy Works and many other sources there are useful suggestions for both how to avoid failing important tests and how to recover after we have failed minor or major tests. Most of these suggestions involve efforts to more effectively understand the client's pathogenic beliefs and tests and/or to slow the process down if we're not sure what the testing involves.

Less frequently discussed in my experience with CMT involves what happens when the rupture/failed test involves the therapist's overlapping pathogenic beliefs/attachment vulnerabilities, as seems to be fairly common in my personal and supervising experience. In this regard, I particularly appreciated Wallin's emphasis on the inevitability of attachment disruption (or failed tests) in many therapeutic encounters. As he stated: "therapy heals when a new attachment can allow the core vulnerabilities of the patient and the therapist to be engaged and successfully managed." If we're fortunate, rather than falling into a pit of self-recrimination, we become aware that what is being activated in us by our clients typically connects to their own unresolved trauma (especially in passive into active testing). But this knowledge alone doesn't eliminate our need and responsibility to work on our own part of the disruption/failed test. With some humorous self-deprecation, Wallin suggested that he "might be more fucked up than other therapists'' and gave numerous examples of therapy disruptions (failed tests in CMT) where his own attachment vulnerabilities overlapped with his clients such that he was not helping (and was told so by his clients). He then described the various ways that he went about repairing the disruptions, inevitably reflecting on his own vulnerabilities and even sharing some of these with his clients in an effort to take responsibility for his part in the disruptions. He ended this discussion by suggesting that for the patient to fully heal, the therapist must also change in the direction of pursuing "inner acts of freedom" to repair our own relational wounds.

In my CMT translation of this discussion, our case specific plan formulations may be necessary but not sufficient when our own pathogenic beliefs/attachment vulnerabilities are triggered by our clients' parallel beliefs/vulnerabilities. In a way that I found both liberating and challenging, I was reminded of my responsibility to continually work on my own self-healing, as well as the (case specific) option to share my own overlapping struggles with my clients as a potential pathway to repair disruptions/failed tests.

Shortly after this discussion, with Wallin's similar example echoing in the background, I took the opportunity to share with a guilt and shame ridden client both my own guilt about charging her additional funds when her insurance coverage soon expires and my parallel compassion for myself in asking for the additional fees (this after she complained about my policy). I also suggested a compromise in the increased fee until her insurance kicks back in. In exploring her reaction to this self-revelation and recommendation, the client was hugely relieved to know that I struggle in some similar ways that she struggles (thus reducing her shame) and also that I could find a way to balance my care for her and care for myself, thus also modeling a pathway for herself toward relieving her own guilt toward her parents and others. Thanks to David for the useful reminder of our inevitable humanity and for the encouragement for us healers to continually seek our own healing.

The second take-away from Wallin's talk involved the emphasis in attachment theory and research on the primacy of preverbal experience in making up the :"core of the developing self." In parallel, its no great revelation that many pathogenic beliefs start developing well before the child has developed language to make sense of their experience . The clinical implication of this finding, according to Wallin, is that it might be useful to more frequently tune into the nonverbal/bodily based/emotional aspects of transference and countertransference with our clients; otherwise what can't be said or isn't yet "known" will likely be evoked in us and enacted in a way that may prevent successful resolution of the "unverbalizable" experience. Here's how I translate these insights into Control Mastery theory and practice.

I have come to believe over time that many of our clients' central pathogenic beliefs involve the perceived danger of accessing and expressing their core emotional experience, based on compliance with the verbal and non-verbal messages of caretakers from infancy onward . These messages are internalized by the child preverbally and beyond (e.g., "big boys don't cry," "good girls don't get angry."). Fortunately, the body is the carrier of emotional experience, and those emotions which might be too dangerous to access or express in words remain accessible in bodily experience/sensation/imagery/energetic experience/etc, both within the client and/or the therapist. For our clients with such pathogenic beliefs, Wallin's insights are particularly relevant. For example, an adult male client who has typically avoided emotional expression in our work recently described a vague sense of anxiety as we discussed his sister's frequent anger at him. As I asked him to locate and describe this anxiety in his body, he described a sensation of "shivering and coldness in the pit of (his) stomach." Inviting him simply to stay with this sensation for a minute or two, with no further prompting he soon recalled when he first felt these sensations, when his alcoholic father would yell at him "for no reason" as a child. Reflecting on my own sensations, I suggested a possible feeling of fear. He then elaborated on his own fear as well as a desire to yell back at his father, an anger that he suggested felt way too dangerous to feel and express given his father's rages (thus the warning signal of anxiety whenever he would begin to feel angry at anyone, including his sister). In this interaction, starting primarily with bodily sensations ended up leading to an important repressed memory and insight. Hopefully, further such work over time can further transform his pathogenic beliefs about the perceived dangers of such core, initially preverbal and embodied emotional experience.

There is nothing in this contribution from attachment theory regarding the importance of preverbal and bodily based experience that can't be successfully integrated to CMT theory and practice, as I suspect is already old news for many in CMT circles. The gift of CMT is its simplicity in understanding the development of pathogenic beliefs and its case specific and wonderfully flexible approach to overcoming these beliefs. Attachment theory's highlighting the crucial role of attending to our own attachment vulnerabilities (and pathogenic beliefs) as we interact with our clients, the value of occasionally sharing these with clients in the disruption/repair/ test passing sequence, and the value of attending to preverbal/bodily based experience hopefully give us even a wider range of options in helping our clients manifest their unconscious plans.