Dear Colleagues,

Thanks to all the teachers and participants of the 26th Annual International Conference on Control Mastery Theory. The conference was well received from the Introduction to CMT the Saturday before to the end of the intensive five-day conference. We had another five students from Bergen and four of them expressed their wishes to come back as interns in our Clinic.

One of the important goals of the yearly conference is to develop relations with people in different areas of the country and around the world. We have had a wonderful collaboration with our friends in Norway who have sent scores of faculty and students over the years to the conference and many students have served as interns in the clinic. Hans Peter Broch, Tor Sletten, and Kari Lossius have invited people from our group to come and lecture at conferences that they sponsor and they have come year after year to participate in our yearly conference here.

We are trying to develop similar relations with students and practitioners at other places. We already have connections at Smith College where Bob and Cynthia Shilkret teach and from where many students have come to be interns at our clinic. Last year, former SFPRG intern, Susan Evans came to the conference from Portland. We set up a conference in Portland on April 6 (in two weeks) in collaboration with the Portland Psychoanalytic Society. We are hoping that people in Portland who are familiar with CMT will come and bring their students as well as those in the psychoanalytic community, who might come to learn about CMT for the first time. Our hope is that some who come to the Portland conference will want to come next year to the 27th International Conference here and we would like to send more faculty back to Portland in the near future to offer more conferences there.

I spoke with Sandy Wolf, one of this year's conference returnees from New Haven about setting up a similar conference in New Haven. She learned about CMT from Jo Nol, who is a long-standing member of the group and who currently teaches and practices in New Haven. Jo has put on CMT conferences in New Haven in past years. Sandy is willing to help set up a new conference there in collaboration with Jo and faculty from our group. Again, our idea would be to develop a rich relationship with the community in the New Haven area where students and practitioners can come here and we can send people there to further develop Control Mastery Theory.

We have been thinking of setting up similar conferences in Los Angeles, Boston, and in Vancouver. If you are interested in teaching, traveling, or having a CMT conference set up in your community, please contact us and we will plan it together.

I also want to announce/remind readers that SFPRG is putting on an important spring conference on Saturday, April 13 on the use of CMT and CBT in treating trauma. Presenters include Victoria Beckner, who has written an excellent book on PTSD, Susan Landes, and Ginger Rhodes, two clinicians in our group with extensive experience and expertise in treating trauma. In addition to exploring the nature of Posttraumatic Stress Disorder, the presenters will talk about the important role of safety in CMT and in CBT, some of the converging and diverging implications for treatment. Even though exposure is a central part of CBT, it will be discussed as a common feature of many therapies, and especially how it relates to Control Mastery Theory.

I hope to see you all at the spring conference. Have a wonderful month.

Steve Foreman

The 26th Annual International Conference on Control Mastery Theory has come and gone. I was able to spend three full days at the conference this year and attended many interesting workshops including the Morning class for people new to CMT, CMT and CBT, CMT and Chronic Illness, CMT and Difficult Adolescents and lastly the workshop on the Future of CMT. I learned a lot of interesting and applicable ideas on how to improve the work I am doing. Each year I attend the conference I learn new ways to implement CMT and how to continue to improve and grow as a psychotherapist. In our next issue I will give you a more detailed overview of the workshops I attended.

If you have not already done so, please register for our upcoming conference on the Role of Exposure and Safety in Two Treatments for Trauma: CMT and CBT. See below for more information. We will be leaving plenty of time to discuss cases involving this complex work. Also, we are in the planning stages of a conference in the fall on addressing addiction in out patient psychotherapy.

The Role of Exposure and Safety in Two Treatments for Trauma: Control Mastery Theory and Cognitive Behavioral Theory

Saturday, April 13, 2013, 9:00 - 4:15 pm (6 CE Hours)
JCCSF, 3200 California at Presidio Street, San Francisco

This class will introduce the attendees to trauma work through a comparative look at the approaches of Control Mastery Theory and Cognitive Behavioral Therapy, with a special emphasis on the role of exposure (trauma-focus work) and safety in both treatments. The workshop leaders will first provide an overview of how each treatment approaches the challenging task of helping the client work through the trauma (which necessarily involves exposure to the trauma memory and working through pathogenic beliefs), and how safety is created and maintained through this process. The leaders will then highlight the commonalities and divergences of the two orientations. The class will also explore the physiology of trauma, trauma memories, and how this informs each treatment. Participants will gain knowledge of these approaches and two key therapeutic processes (exposure and safety) through the presentation of didactics, discussion, and the application of case material.

Faculty: Victoria Beckner, PhD; Susan Landes, PsyD; Ginger Rhodes, PhD

Dr. Beckner has a psychotherapy practice with the San Francisco Group for Evidence-Based Psychotherapy, and does teaching and research at UCSF. Her work over the last 14 years have focused on the nature and treatment of stress, anxiety, trauma and depression, and also the role of emotion and stress hormones on memory. While her clinical approach combines Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) within a humanistic-experiential framework, she has a growing interest in understanding transtheoretical models of psychotherapy process and mechanisms of change in clients. She is the lead author of a book for trauma survivors: Conquering Post-Traumatic Stress Disorder.

Dr. Landes has been working in the fields of mental health and addiction since 1987. She received her master's degree in Clinical Psychology with a Specialization in Alcohol and Other Drug Addiction from J.F. Kennedy University in 1989. Susan earned her doctorate from the Wright Institute in 2003. In 1990, Susan was introduced to Control Mastery Theory and SFPRG. Susan currently has a psychotherapy practice with offices in San Francisco, Oakland and in Auburn. She also provides supervision, consultation and program design and development for several substance abuse treatment programs and has been an adjunct professor at CSU Sacramento and at Alliant International University.

Dr. Rhodes treats complex trauma survivors in her private practice in San Francisco. She provides trauma-related seminars and supervision for trainees at the SFPRG Clinic and Training Center. Dr. Rhodes also conducts psychological evaluations and provides expert witness testimony for torture survivors applying for political asylum in the United States.

Register online at www.sfprg.org
Register now! Price increases on April 5th.

This month we are profiling Kathie Dunn for the work that she has done during her years as a member of SFPRG. We all give our sincere thanks to Kathie for developing our newsletter, and being its editor from 2006 through 2012. Kathie was also a member of the board of directors from 2008 until 2012, and served as chair of the membership committee, an often thankless task.

Kathie came to psychotherapy and to SFPRG through a circuitous route, after a career in the retail nursery business. An injury resulted in back surgery which led to the Department of Rehabilitation financing an AA degree in Speech Communication. After receiving this degree, the Department also agreed to pay for her to obtain her Bachelor's degree in Communication Studies, which she obtained in 1997. Kathie then went on to earn her Masters degree in Ed. Psych with an MFT option, and in 2004 was licensed as a Marriage and Family Therapist.

Kathie came to Control Mastery Theory when she was receiving supervision as a private practice intern from Melanie Clark, a long time SFPRG member. She was immediately attracted to the theory because of its orienting nature, and how well it provided the therapist with an understanding of the patient's particular dynamics and issues. It felt natural to her and provided a structure and framework to ways she was already thinking.

In Kathie's clinical practice is in located in Benicia, where she is a member of the Benicia Family Therapy Clinic, a private practice group. In her practice she works with couples, individual adults, teens and children. Over the years she has worked with a number of populations, including sexual offenders and people accused of committing acts of domestic violence. She is also skilled in working with couples around pre-marital issues, and finds that CM theory applies equally well to the various modalities in which she works.

Over the past two years Kathie has expanded her work to include mediation, and has received extensive training as a mediator. In her capacity as a mediator she has worked with the Congress of Neutrals in Walnut Creek as a volunteer, on whose board of directors she now sits. She has also worked with the Victim/Offender Reconciliation Program in Contra Costa County, working with juvenile offenders through the juvenile probation department in Antioch.

In her mediation practice Kathie helps couples around step-parenting issues, post-divorce co-parenting, and helping families find resolutions to difficult problems. She very much likes the voluntary nature of the mediation process, the neutral nature of her work, and the creating an atmosphere in which healthy communication can take place.

Kathie values SFPRG as an organization that provides a great service to clinicians. The organization has helped her develop and hone her clinical skills, and has helped provide her with a solid base for both her psychotherapy and mediation practices.

Kathie Dunn can be reached at her office at 707-746-0122 ext 5# or on her cell at 707-227-2627. Her email address is kathiedunnmediation@gmail.com.

Congratulations to SFPRG Members Jessica Broitman and Jack Davis who have a new book out to follow their previous book on NVLD:
Treating NVLD in Children: Professional Collaborations for Positive Outcomes

Children with nonverbal learning disabilities (NVLD) have needs that can take many forms and may, over time, require consultation and collaboration with professionals from several fields. Given that multiple specialists may be involved in working with children with NVLD - as well as the array of treatment variables - even seasoned practitioners may find themselves in confusing situations. Treating NVLD in Children takes a developmental view of how the problems and needs of young people with nonverbal learning disabilities evolve and offers a concise guide for professionals who are likely to contribute to treatment. Expert practitioners across specialties in psychology, education, and rehabilitative therapy explain their roles in treatment, the decisions they are called on to make, and their interactions with other professionals. Collaborative interventions and teamwork are emphasized, as are transitions to higher learning, employment, and the adult world. Among the book's key features are: A new four-subtype model of NVLD, with supporting research. A brief guide to assessment, transmitting results, and treatment planning. Chapters detailing the work of psychologists, therapists, coaches, and others in helping children with NVLD. Material specific to improving reading, writing, and mathematics. Overview of issues in emotional competency and independent living. An instructive personal account of growing up with NVLD. Treating NVLD in Children: Professional Collaborations for Positive Outcomes is a key resource for a wide range of professionals working with children, including school and clinical child psychologists; educational psychologists and therapists; pediatricians; social workers and school counselors; speech and language therapists; child and adolescent psychiatrists; and marriage and family therapists.

This is Part Two of an article called "Pathological Identification." Part One appeared in last month's newsletter

Anna Freud
In her paper, "Identification With the Aggressor" (11), Anna Freud added "mastery" as a new component in understanding the function of identification in traumatic or threatening circumstances. She began with a story of her colleague, August Aichhorn, who had consulted on a case where a young boy was making faces at his teacher while being scolded in school. The headmaster felt the boy was either making fun of the teacher or possibly suffered from an involuntary tic. Aichhorn noticed that the grimaces the boy made were a caricature of the angry expression of his teacher and hypothesized that the boy "tried to master his anxiety by involuntarily imitating" his teacher. "Through his grimaces, he was assimilating himself or identifying himself with the dreaded external object" (11, p.110)

Freud went on to describe several more examples of children who identified with the aggressor in order to master anxiety. One example was of a young girl who was afraid of ghosts. She ran through the hall in her house, acting like a ghost. She told her little brother, "There's no need to be afraid in the hall, you just have to pretend that you're the ghost who might meet you." (11. p. 111)

She gave a third example of a child who had endured a visit to the dentist, came home, and engaged in aggressive play. Though not specifically playing the role of the dentist, Freud said she identified with his aggression. She concluded, "there are many children's games in which through the metamorphosis of the subject into a dreaded object anxiety is converted into pleasurable security" (11, p. 111).

In the same chapter, Anna Freud went on to describe how children may not just identify with the aggressor to master anxiety over being traumatized but they may become aggressive in identification with a parent who they expect will punish them for unacceptable impulses. Like Sigmund Freud in "Dostoevsky and Parricide" (8) and in "Mourning and Melancholia" (9), she linked the fear of punishment with guilty wishes. She described a "certain boy, when his Oedipus complex was at its height," who periodically had outbursts of aggression and anger towards his mother because she was too curious. Anna Freud formulated that the boy imagined the mother knew of his libidinal feelings for her and he expected she would aggressively reproach him for them. Freud formulated that the boy projected his "scoptophilic impulse" onto his mother, accusing her of being too curious, while identifying with her supposed anger and indignation in response to his libidinal feelings for her. "The reversal of roles was complete," she wrote. "He assumed his mother's indignation and, in exchange, ascribed to her his own curiosity" (11, p. 117). In "Identification with the Aggressor," Anna Freud linked projection, identification, and reversal of roles in a way that anticipated the work of Melanie Klein.

Melanie Klein
Klein first coined the term "projective identification" in her article, "Notes on Some Schizoid Mechanisms" (12) and developed the concept further in "On Identification" (13). Klein hypothesized that the infant had two main lines of fantasy onslaughts against the mother. First, she described the infant's oral impulse to suck the breast dry, bite it, scoop it out, and rob the mother's body of its good contents. The other line of fantasy attack involved anal and urethral impulses to expel excrements out of the self and into the mother. These excrements were postulated to not only injure but to take control of the object (12, p. 8). Klein suggested that the infant could not differentiate the self from the object so that when the bad parts of the self were projected into the object, the infant felt that the object was not a separate individual but the bad self. Since the infant projected all of her negative impulses and hatred onto the object and then identified with the object, she would feel that the object would want to persecute her.

Klein asserted that the infant projects good parts onto and into the object as well as bad. Identification with the object after projecting loving parts of the self helped the individual develop good object-relations and helped to integrate the ego. Klein argued that this projective-identification process was necessary for normal healthy development as well as was part of abnormal object-relations development. She hypothesized that unbalanced projection and identification led to weakening and impoverishment of the ego and could ultimately lead to schizoid and schizophrenic pathologies (12, p. 11).

Klein posited that in normal development, the infant completely introjects the object and moves from the "paranoid-schizoid position" to the "depressive position" after three months of age. According to Klein, this progression entails less splitting, more integration of loved and hated aspects of the object, increased fear of loss, and new feelings of guilt, grief, and depression over aggressive impulses towards the object (12, p.14). Klein acknowledged (13, p. 141) that the inter-relationship she described between projection and introjection harkened back to Sigmund' Freud in "Mourning and Melancholia" (9).

Fairbairn
Fairbairn asserted that "in early childhood, all object relations are based on identification" (14. p. 64), an insight that he credited to Sigmund Freud (7, p. 35). Fairbairn noted that the super-ego that Freud described as an internal psychic structure derived from identification with the father (7. p. 44) "must be regarded as essentially an internalized object" (14, p. 61).

Fairbairn was particularly interested in the child's repression of and identification with what he called "bad objects." He had clinical experience with delinquent children who came from homes where parents were drunk, quarrelling, and abusive. He observed that children in these families were very rarely willing to volunteer or even admit that their parents were "bad objects." He described children who had been sexually abused who tended to repress the details of their abuse in marked contrast to the abusers who had little difficulty remembering the details of the abuse.

Fairbairn went on to observe that these delinquent children who were reluctant to admit that their parents acted badly had no reluctance admitting that they themselves were bad. "The child would rather be bad himself than have bad objects... (O)ne of his motives in becoming bad is to make his objects 'good... To say that the child takes upon himself the burden of badness which appears to reside in his objects, is of course, the same thing as to say that he internalizes bad objects" (14, p. 65). Fairbairn summarized the phenomenon in his oft quoted maxim, "it is better to be a sinner in a world ruled by God than to live in a world ruled by the Devil" (14, p. 66-67).

Fairbairn explained this repression of and identification with bad objects by suggesting that it makes the child feel more secure to be in a sane world, even if it means the child has to view himself as bad. He concluded, "Outer security is thus purchased at the price of inner security"(14. p. 65). The tendency of abused children to protect their abusers has been described elsewhere (1 p. 128,15, 16).
(To be continued.)

References

1. Foreman, S.A., Breaking the Spell, Understanding why Kids Do the Very Thing That Drives You Crazy, SF Press, 2009.

2. Weiss, J. & Sampson, H., The Psychoanalytic Process, Guilford, New York, 1986.

3. Weiss, J. How Psychotherapy Works, Guilford, New York, 1993.

4. Freud, Sigmund, "Family Romances" (1909) in Collected Papers Volume V, Ed. By James Strachey, Basic Books, New York, 1959, pp. 74-78.

5. Freud, S., "Humour" (1928) in Collected Papers Volume V, , Ed. By James Strachey, Basic Books, New York, 1959, pp. 215-221.

6. Freud, S., "Distinction Between the Sexes" (1925) in Collected Papers Volume V, , Ed. By James Strachey, Basic Books, New York, 1959, pp. 186-197.

7. Freud, S., "The Ego and the Id" (1927), Standard Edition, 19.

8. Freud, S., "Dostoevsky and Parricide" (1928) in Collected Papers Volume V, , Ed. By James Strachey, Basic Books, New York, 1959, pp. 229-231.

9. Freud, S., "Mourning and Melancholia" (1917) in Collected Papers Volume IV, , Ed. By James Strachey, Basic Books, New York, 1959, pp. 152-170.

10. Niederland, W.G., "The Survivor syndrome: Further observations and dimensions," Journal of American Psychoanalytic Association, 29, 1981, pp. 413-426.

11. Freud, A, "Identification With the Aggressor," The Writings of Anna Freud Vol. 2, The Ego and the Mechanisms of Defense, International Universities Press, Inc., New York, 1936, pp. 109-121.

12. Klein, M., "Notes on Some Schizoid Mechanisms" (1946), The Writings of Melanie Klein Vol III, Envy and Gratitude and Other Works 1946-1963, Macmillan, Inc. New York, 1984, pp. 1-24.

13. Klein, M., "On Identification' (1955), ibid., pp. 141-175.

14. Fairbairn, W.R.D., "The Repression and the Return of Bad Objects" (1943), Psychoanalytic Studies of the Personality, Routledge, New York, 2002.

15. Summit, R., "The Child Abuse Accommodation Syndrome", Child Abuse & Neglect, 7, 1983, pp. 177-193.

16. Foreman, S.A., "Survivor Guilt in Sexually Abused Children," presented at the California State Psychological Association Annual Convention, San Francisco, CA February, 1986.