Dear Colleagues,

We are planning a seminar, New Developments in CMT, Theory and Research. People are invited to present new ideas in theory and new proposals in research to further develop and test Control Mastery Theory. Marshall Bush and I are hosting a series of two or three conferences starting Saturday, August 10, 2013. The second meeting will probably be Sunday, September 15, 2013 and the third will be scheduled for October. We plan to use these two or three no-fee seminars to clarify where we are in Control Mastery Theory, what questions need to be addressed next, and what research projects will follow from these discussions. I am hoping that those interested will form a group, co-led by Marshall and me, who will meet monthly thereafter to discuss research projects and to support each other to write and publish on CMT. These conferences will count for continuing education credits.

If you want to present in August or September, please contact me so we can put you on the schedule. Depending on how many presenters we have, we will either offer a half-day or full day program. People may present for 20 minutes if we have a lot of presenters or an hour if we have the luxury of more time. We would like to include small summaries of each person's ideas for publication in the newsletter for the month of the presentation. We also need descriptions of your presentations with written learning objectives so we can offer CEUs to all participants. It should be a very exciting and interesting conference.

I also want to encourage everyone to come to the Summer Samba. SFPRG invites you to our first summer SFPRG party at Jessica Broitman's home on July 21, 2013 from 2 to 5 pm. See the evite that was sent this month that also has a google map. It will be a great party. Please come.
Have a wonderful summer. See you next month.
Steve Foreman

We would love to see you at our events! Please put these dates into your calendar and come enjoy time with your colleagues! July 21 we are having a party in Berkeley. September 7th is our Honorary Dinner fundraiser which will be at a restaurant in SF. October 26 we will have our Art Show & Reception at our offices in The Presidio. More information will be forthcoming on all these, but please put them in your appointment calendar!

Take a look at pictures from some previous events: http://www.flickr.com/photos/sfprg/

Hello Community,
Happy summer. The Education Committee is working on organizing the fall conference on Addiction and CMT. It has been 20 years since Lynn O'Connor and Joe Weiss wrote the paper, "Individual Psychotherapy for Addicted Clients: An Application of Control Mastery Theory." I have used that paper in my capacity as training director, supervisor and adjunct professor all these years to teach graduate students how to work with substance abuse. The list of pathogenic beliefs common among addicted clients found in the paper has been incredibly helpful to students grappling with the challenges of treating addiction. Drug use is often a symptom, a coping strategy, for people who have difficulty managing their feelings, especially feelings associated with relationships. Often these feelings are generated from pathogenic beliefs such as: by not drinking or using drugs one will risk a breach in attachment to parents, siblings or loved ones, or, that recovery means outdoing or belittling a parent or sibling. Educating psychology students how to work with addiction has been a large and rewarding part of my career. I'm looking forward to this conference furthering our understanding of this devastating but treatable illness.

The committee is also looking at the format of the March Workshop. There have been some suggestions that we make some changes. One idea is to shorten the number of days. Another is to offer less workshop topics or have people sign up for specific topic in advance. Please let me know if you have some thoughts on how the workshop might be enhanced.

Lastly, we are continuing our efforts to bring CMT to other parts of the country. As a result of that effort one of our members will be starting a Case Conference on the East Coast.

This month we continue to update you on our graduated interns with John Synder, Psy.D. who completed his post doc in 2012. We are thrilled that John continues his work as Director of Research at the SFPRG Clinic and Training Clinic. He oversees and manages the data collection for all our research projects. He will be working closely with current intern Vale Gandhi. John was recently awarded a grant to purchase 4 PC tablets for the Training Clinic. The tablets will be placed in the clinic waiting areas and utilized by clinic patients to fill out research questionnaires on their therapeutic progress. John describes his plan: "The goal is to streamline the data collection process and to make session feedback immediately available to clinicians, a practice that has been empirically demonstrated to enhance treatment outcomes (Berking, Orth, & Lutz, 2006; Harmon et al., 2007; Simon, Lambert, Harris, Busath, Vazquez, 2012)" . John will be traveling to Brisbane, Australia in July to present his original research conducted at the SFPRG Clinic and Training Center.

In addition John is also assisting the training clinic in transferring to an entirely paperless electronic records keeping system. The electronic records keeping system will expose SFRPG interns to current records keeping practices, and allow the clinic administration to keep better track of patient records. We are joining the 21st century!

John, a gifted therapist, is also in the process of building his own private practice. He specializes in the treatment of men, adolescents, and physical and sexual trauma (perpetrators and survivors). He has years of experience working with men and woman who are on parole or probation. his fees are: $150 per session.

His office is located in The Presidio SFPRG Clinic, and he is currently accepting referrals for new patients. Dr. Snyder can be reached at 415-793-9583 or jdsnyder22@gmail.com

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

Clinical Examples
The Man With Nazi Genes.
William was a fifty year-old dentist who had been married to a woman with a teenage son from a previous marriage. He recollected coming home from work at the end of the day. As he drove up the driveway, he could feel himself turn from Dr Jekyll to Mr. Hyde. He became hostile and surly, sarcastic and verbally abusive to his step-son as soon as he walked in the front door. Although he was no longer married and no longer saw his step-son at the time he began our therapy, he was still quite disturbed by his earlier abusive behavior. In our initial session, he complained that he was currently treating a secretary at work very badly in much the same way as he had treated his step-son a few years before.

When I asked him why he thought he had acted so mean to his step-son and then again to his secretary, he explained that it was a biological problem. He believed that because his mother was of German origin, he had genetic tendencies toward sadism. Basically, he believed he carried "Nazi genes."

When giving an initial history, he had only vague childhood recollections about his parents. Over time, he gradually recalled memories of his father as quite critical and sadistic toward him as a child in exactly the same way as he later acted toward his step-son and secretary.

While remembering more about how his father treated him, he also described protective feelings towards his father, who was elderly and quite ill at the time. He was particularly worried that there was no one in the family other than he who was willing or able to take care of his father. The more he talked, the more clearly he remembered how his father had treated him, and the more aware he became how angry he felt. He confided that he was afraid he might stop being available to his father if he got in touch with his anger. He worried if he was not available and willing to help his ailing father, his father might die.

Much of the therapy involved his remembering more of what his father did to him, facing his angry feelings about his father, and wrestling with his anxiety that he would get so angry that he would abandon his father. He did not abandon his father, as he feared. He was able to remember his father and feel his feelings more clearly. The more we talked about his father, William became more kind and solicitous toward his secretary, which surprised him. After two years of therapy, he became very warm and caring toward his secretary and he eventually dispensed with his theory that he had "Nazi genes."

The Father Who Didn't Remember Being Abused.
Richard was a very successful, forty-three year-old attorney, married for twenty years with two children in private school. I treated Marc, the older of his two high-school boys, for complaints of anxiety and underachievement at school. An avid sportsman, Richard was handsome and likeable. In his history, he remembered his relationship with his parents as fairly ideal and his childhood was only remarkable for how successful he was as a student and athlete.

Richard intermittently became enraged at Marc and often humiliated him for his academic failures, calling him a "loser." Early in the treatment, after an argument at home, Richard lost control, leapt across the family room, and started to punch Marc in his back and shoulders. Marc's mother, Julie, pulled Richard off of her son and then told her therapist, who reported the incident to Child Protective Services. Soon after the abusive incident, I met with both parents. I asked Richard if anything like this had ever happened before and specifically if his parents had ever treated him this way. He said he couldn't remember any such incidents and only remembered his parents as positive and supportive.

I found that difficult to believe but took him at his word for the moment and talked about strategies to deal with his angry feelings towards Marc without violence. A month later, Richard told me he had spoken with his adult sister about this event. She, who was working in her own psychotherapy at the time, told Richard that she clearly remembered their parents abusing them physically and verbally as children. He said he believed her but had no personal recollection of any abuse.

I have treated scores of cases of child abuse and in almost every case, the abusive parent was abused in childhood. In addition to repeating the abusive behavior faithfully, abusive parents typically justify the abuse as correct and appropriate. One abusive parent, when asked how he was disciplined as a child said, "My parents whupped me and they were right to do it." Alice Miller wrote, "By the time of my therapy, I had grasped the fact that I had been abused as a child because my parents had undergone similar experiences in their childhoods and had learned to regard that abuse as having been for their own good" (47, p. 8).

The Man Who Owed the IRS.
Not all pathological identifications are repetitions of abusive behavior. Charlie was a thirty-eight year-old accountant who recently married and planned to have his first child. He had developed a successful business but had failed to pay taxes for the last two years. He told me that his father was a tax attorney who had regularly cheated on his taxes and was caught. His father went into financial ruin, got divorced, left the family in shame, and spent years trying to get out from under terrible debt to the IRS. Now as Charlie was planning to launch his new family, he was flirting with the same financial disaster that crushed his father by not paying his taxes.

The Boy Who Couldn't Finish His School Work.
Elliot was a brilliant twenty year-old college junior with Obsessive Compulsive Disorder. He entered treatment after he came home from his Ivy League college mid-semester on a medical leave. He had stopped handing in papers for all of his classes. He couldn't finish them because he thought they weren't perfect enough. His writing was so good that several of his teachers were willing to give him A's even though he hadn't finished all of his work because his earlier compositions were so brilliant. He complained that it would be morally wrong to accept A's or even passing grades without doing all of the required work. He could have easily passed some of his classes if he would just hand in anything. His arrangement with the Dean was that he could have incompletes in all of his classes but he had to finish five or six papers during his leave.

Elliot was the oldest of four children. His mother was a successful businesswoman who supported the family. His father, who described himself as depressed, had been a successful attorney but was laid off from his firm for the second time. He spent most of his time loafing at home, unable to find new employment. Elliot described his father as "pathetic" and said he had no respect for him.

Elliot first developed problems with procrastination, failing to hand in papers in seventh grade. His father had lost a well paying job as an attorney for the first time in the same year. Elliot described the home environment as "stressed" about money and his mother and siblings were angry at his father. He said, "I was really angry at him. I fantasized about stabbing him." When I asked about his strong feelings about his father, he said, "I don't think about him. I'm numb to him. If I think about him, I'd be saddened. I feel bad saying this -- if Dad died, I wouldn't be sad. That makes me a horrible person."

His father got another job two years later, but at a much lower salary. He was laid off again in Elliot's junior year at college. When Elliot started therapy, he complained of depression and anxiety. He said he felt he was "pathetic." He had been on antidepressants before coming home from college but insisted on going off his medicines as soon as he started seeing me. His mood immediately got worse and he finally agreed to go back on his medicines, but at a lower dose than before.

After stabilizing his mood with medicine, I tried to work with him to complete his schoolwork. He was not very compliant and seemed to make glacial progress. Due to the intensity of his perfectionism and his obsessive paralysis, I decided to refer him to a very experienced Cognitive Behavioral therapist who had much more experience with Obsessive Compulsive Disorder than I, and because I wasn't making much progress with him.

He saw the other therapist for three months and was sent back me. His therapist was very frustrated and angry because Elliot refused to do homework, refused to cooperate with therapy, and made no progress.

When he returned to therapy with me, I tried a more psychological approach by suggesting that he was identifying with his father. I thought this because his symptoms of not handing in papers first started in seventh grade after his father first lost his job. It was happening again as his father lost his job again. He had great scorn and anger for his father about which he felt guilty. He called himself "pathetic", the same word he used to describe his father. I thought he was putting himself in the same predicament as his father. Now everyone was focused on Elliot, how he couldn't get anything done and how he was "pathetic." Even his cognitive behavioral therapist was angry with him in the same way he was angry with his father. It seemed that he was unconsciously protecting his father from his and everyone else's scorn and anger by acting like him and assuming his role.

I suggested this formulation to him. He was actually quite interested in the idea and the psychological meaning of his symptoms. But he didn't change his behavior. In fact, he said he got worse. We tried various medication trials to address his intractable OCD. Elliot expressed "a crisis of confidence" about my ability to help him. I sent him for second opinions and specialty consultations. He finally allowed increased doses of medications to help him with his OCD and even consented to go back to cognitive behavioral therapy with another therapist.

His behavior did not substantially change until his father got a good paying job and finally went back to work. After his father was able to get out of the house, Elliot was able to finish his incompletes and went back to finish his senior year at college.
(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.

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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.

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

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18. Modell, A., "Self-preservation and the preservation of the self: Overview of the more recent knowledge of the Narcissistic Personality," The Psychotherapy Research Group Department of Psychiatry, Mount Zion Hospital and Medical Center, Bulletin #6, June, 1983, 1-11.

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22. Bateson, G., Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology, University of Chicago Press, Chicago, 1972.

23. Searles, H.F., Collected Papers on Schizophrenia and Related Subjects, International Universities Press, New York, 1965.

24. Laing, R.D., The Divided Self, An Existential Study in Sanity and Madness, Penguin, Harmondsworth, 1972.

25. Feiner, A. & Levenson, E.A., "The compassionate sacrifice, An explanation of a metaphor, Psychoanalytic Review, 55, 1968-69, 552-573.

26. O'Connor, L.E., "Pathogenic beliefs and guilt in human evolution," in Genes on the Couch: Explorations in Evolutionary Psychology, Ed. By P. Gilbert & K. G. Bailey, Routledge, New York, 2002.

27. Zahn-Waxler, C. & Radke-Yarrow, M., "The development of altruism: Alternative research strategies," in The Development of Prosocial Behavior, ed. By N. Einsenberg, Academic Press, New York, 1982.

28. Gopnik, A., Meltzoff, A., & Kuhl, P. The Scientist In the Crib, What Early Learning Tells Us about the Mind, Perennial, New York, 2001.

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30. ----------, The Descent of Man and Selection in Relation to Sex, Princeton University Press, Princeton, 1981 (1871).

31. Hoffman, M.L., "Is altruism part of human nature?" Journal of Personality and Social Psychology, 40, 1981, 121-137.

32. Wynne-Edwards, V.C., Animal Dispersion in Relation to Social Behavior, Oliver and Boyd, Edinburgh, 1962.

33. Hamilton, W.D., "The genetic evolution of social behavior," Journal of Theoretical Biology, 7, 1964, 1-52.

34. Trivers, R.L., The evolution of reciprocal altruism,", Quarterly Review of Biology, 46, 1971, 135-137.

35. ----------, Social Evolution, Addison-Wesley, Boston, 1985.

36. Bowlby, J., Attachment, Basic Books, New York, 1982, 133.

37. Iacoboni, M., Mirroring People, The Science of Empathy and How We Connect With Others, Picador, New York, 2008.

38. Nelson, F. & Panksepp, J., Brain substrates of infant-mother attachment: Contributions of opioids, oxytocin, and norepinephrine, Neuroscience and Biobehavioral Reviews, 22:3, 1998, 437-452.

39. Newton, N., The role of oxytocin in three interpersonal acts: coitus, birth, and breastfeeding, In Clinical Psychoneurendocrinology in Reproduction, Ed. By L. Carenza, P. Pancheri, and L. Zichella, Academic Press, New York, 1978, 411-418.

40. Swanson, H., Peptides, in Brain Mechanisms and Psychotropic Drugs, Ed. By A. Baskys & G. Remington, CRC Press, Boca Raton, 131-152, 1996.

41. De Dreu, C.K.W., et. al., "The neuropeptide oxytocin regulates parochial altruism in intergroup conflict among humans", Science, 11:328, 2010,1408-1411.

42. -------, et. al., "Oxytocin promotes human ethnocentrism", Proceedings of the National Academy of Sciences, 108:4, 2011, 1262-1266.

43. Friedman, M., "Toward a reconceptualization of guilt, Contemporary Psychoanalysis, 21, 1985, 501-547.

44. Freud, S. The Unconscious, 1915, 116-150.

45.--------- Introductory Lectures on Psychoanalysis, Norton, New York, 1966.

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47. Miller, A., Banished Knowledge, Facing Childhood Injuries, Doubleday, New York, 1985.

A therapist who rents in our building at 10 Funston is looking to sublet her furnished office on Tuesdays and Fridays. If you would like more information please email christasantangelo@yahoo.com

SFPRG has started our annual Membership Drive. Thank you to those that have already sent in checks or renewed online. We rely on members to help keep SFPRG running.

Please renew your membership at the highest level you are comfortable with. If you are not yet a member, please "pay it forward" and help us spread this wonderful theory by supporting SFPRG with your membership.

Go to sfprg.org to renew or join today! Thank you!