Dear Colleagues,

I am writing to ask you to renew your membership to SFPRG if you have not done so already. Your membership and your donations support our program that is important, valuable, and has three strong components: Clinic, Teaching, and Research.

1) The Clinic is in its twelfth year and getting better every year. This year we have sixteen interns, including two from Norway. Interns at the Clinic are seeing more patients than ever before. A recent survey of former interns to the Clinic noted that, while in training, they felt they received "outstanding supervision," "an excellent grounding theory," and they felt that "Control Mastery Theory was very useful, (they) use it all the time." There is an ongoing research project going on at the Clinic monitoring how well patients are doing and how well their therapists are attuned to them. John Snyder recently reported on this research at a conference in Australia.

2) Our teaching effort to expand and promote Control Mastery Theory is very strong. Even though SFPRG has been putting on excellent program for years, recent conferences including the Lou Breger conference on treatment outcome and the David Wallin conference on Attachment Theory have attracted over one hundred participants each. We are scheduled to have another important conference on addiction with Terence Gorski on October 12 that we think will draw a large audience. Last fall, we offered an introductory seminar on CMT in Portland and are planning other out of state programs in the near future. These offerings are in addition to our usual slate of case conferences, research seminars, and the wonderful yearly International Conference on CMT each March.

3) Research has always been one of the central, validating components of Control Mastery Theory and the San Francisco Psychotherapy Research Group. We have a theory that clinically seems to help our patients and clients get better. This theory helps students and experienced practitioners who come to study with us understand and treat their patients better. But Control Mastery Theory is unusual in that it is one of the few psychodynamic theories that has been operationalized and tested in a research model that parallels the clinical situation. We have demonstrated that independent, blind judges can reliably formulate individual cases, reliably rate therapist interventions according to the patient's plans, and predict how patients process measures will vary in accordance with the planfulness of the therapist's interventions in adults, children, the elderly, brief therapy and long term therapy, using many different process measures of patient progress. That is an accomplishment that deserves to be repeated and promoted.

We are inviting theoreticians and researchers to come and present their ideas at two conferences this fall at 9 Funston, September 15 and October 19. Seven people are scheduled to present their work on various topics including 1) integrating CMT with other models such as Narrative Therapy and Accelerated Experiential Dynamic Psychotherapy, 2) recent research on patient feedback on their therapist's empathy, 3) relating guilt, empathy, and spirituality, 4) the role of "pathological identification" in psychopathology and its treatment, 5) trauma and its treatment, 6) applications to substance abuse treatment, 7) altruism and child development. Experienced clinicians and researchers will present their work testing logical next steps in the theory and its application. We hope the conference will inspire those who have thought a lot about clinical theory or research to present their ideas, get support and give support to others. Our goal is to encourage more writing and publishing about CMT. We also hope to clarify research ideas and point the direction for new dissertation projects.

Finally, we have two wonderful social and fundraising events very soon. Come to the honorary dinner for Stanley Steinberg and Lynn O'Connor on Saturday night, September 7. Click here for details. Also, artists, get your artwork in for the SFPRG Art Show that is scheduled for October 26. We are thinking of adding a wine auction to the art auction. Please put it on your calendar. Enjoy the end of summer. See you next month.

Steve Foreman

This month we continue to update you on our graduated interns with Helga Flasching , Psy.D. who just completed her post doc with us. Helga is a gifted therapist who loves the work and exudes an effortless charm! Helga has been with us for over 5 years which is almost the record. Im thrilled that she has joined the clinic staff as our administrative assistant where she has already proved invaluable. She takes all her clients with her into her private practice and I know you can confidently refer patients to her. She does a great job! In her own words:

I came to SFPRG in the fall of 2009 as a pre-doctoral intern and, what do you know, five years later I'm still involved. In June of this year I finished my post-doc and am now working as a psych assistant to Lesley Parke, Ph.D., until I am licensed. (Have to start studying for that exam in the next few weeks, and I am really not looking forward to it!) Since for some reason I cannot cut the cord, I decided to stay on as "administrative staff" helping Jessica Broitman and Carol Drucker with clinic business and have been working on reviewing and recreating the intern handbook and clinic forms this past month. In addition, I have joined the SFPRG's board and look forward to a productive three-year term. On Saturdays, Mondays, and Wednesdays I can be found working with patients in The Presidio. I enjoy working with adults and couples and am particularly interested in career stress and changes, depression, loss and grief, infertility, late-in-life pregnancy and its challenges, blended/step families, life transitions, personal growth, older adults and divorce. Should anyone run across someone who is looking for a German/Austrian-speaking therapist, please think of me!

I would also like to take this opportunity to thank my supervisors for their generosity and for sharing their knowledge and wisdom: Patsy Wood, Barbara Sapienza, Merri Jaffe, Carol Drucker, Steven Foreman, and Bill Meehan. A big thank-you to Stan Steinberg, Marshall Bush, Jessica Broitman, Michael Lowenstein, Susan Badger, and Terri Myers. My fee ranges from $75 to $125, and I can be reached at 415.505.0799 or drhfasching@gmail.com

September approaches and that means we will welcome our new interns to the clinic. Lindsay Durgan, Miya Drucker, Denise Lew, Beth Mitchner, and Joshua Rothenberg join David K. Becker, Kriste Skogestad Næs and Thomas Kleppestø who started in the summer. We will have lots of room for new clients so please think of us for adults, child family and couple referrals.

Hello Community:

Our fall conference on Addiction is coming together. The conference is titled Current Trends in Addiction Treatment: A Dialogue Between Terence Gorski and Control Mastery Theory. It will be held at the SFJCC on Oct. 12. Click here for registration information. What a thrill it was for me to speak to Terry on the phone about the upcoming conference. While I was in my Addiction Specialization program at JFK University back in the 1980's Terence Gorski's work was all the rage. His ideas about relapse prevention and Post Acute Withdrawal Syndrome (PAWS) added a deeper understanding of the nature and process of addiction to those of us going into the field of addiction. To learn more about him and his work go to his website www.cenaps.com.

Another very valuable contribution to my work in addiction was the 1993 paper Individual Psychotherapy for Addicted Clients: An Application of Control Mastery Theory by Joseph Weiss and Lynn O'Connor. Over the past 15 years I have had every student I have supervised in addiction work read it. I am very grateful to Lynn and Joe for this contribution. My students and I have found the list of pathogenic beliefs common among people suffering from addiction (either themselves or their family member) to be extremely helpful. Lynn has made a tremendous contribution to Control Mastery Theory and to the field of psychology. I was fortunate to have her as a supervisor during my internship at SFPRGCTC. I'm excited to attend the upcoming dinner to honor her and Stan Steinberg and hope to see many of you there.

We are making progress in the planning of the March Workshop. One change this coming year will be to offer beginning and advanced levels of two of our core courses. Another is to have people sign up in advance for the workshops they would like to attend so we don't have imbalances in attendance. If you have any thoughts about the March Workshop, let me know. We are also interested in topics you may have for the March Workshop or future daylong conferences.

The fall case conference information is up on the website now.

This is to announce openings in my Control-Mastery case conference held by telephone. We meet every Tuesday at 11 AM Pacific Time to discuss cases, theoretical issues, and professional matters related to psychotherapy. The conference has a maximum of five members, which insures that there is time for everyone to join the discussions. The group is warm, friendly, and safe, and participants say they feel accepted, free, and comfortable in presenting case material.

I have been associated with Control-Mastery Theory for thirty years, and have been writing and teaching the subject for about twenty years. You can get to know me better, if you like, by visiting my website at www.alanrappoport.com or click the link below. Please write me at arappoport@alanrappoport.com, or call me at 650-556-9500, if you have any questions or would like to talk with me about it.

This is Part Six of an article called "Pathological Identification." Part Five appeared in the June newsletter

Albert Bandura
Some might argue that pathological identification can be explained purely on a cognitive basis, that people act in ways they have learned to act. Albert Bandura's monograph on Social Learning Theory (47) offers a powerful explanation of human behavior based on adaptive learning from important "models" including parents (p. 5). Although most of the learned behaviors Bandura described were positive, he did suggest that aggressive behaviors, for example, were more likely to be learned by those growing up in delinquent gangs rather than in Quaker groups (p. 6).

Bandura argued that four subprocesses are required for observational learning of modeled behavior - attention, retention, motoric reproduction of the behavior, and positive reinforcement for the behavior. In other words, for learning modeled behavior to take place, people need to be aware of the modeled behavior, be able to remember it, be able to reproduce it, and then be positively reinforced for the behavior (pp. 6-7).

This form of learning is not automatic or rote. In Bandura's view, there is a rational and adaptive basis of observational learning. He noted, "(People) can solve problems symbolically without having to enact the various alternatives; and they can foresee the probable consequences of different actions and alter their behavior accordingly." This kind of learning reflects "higher mental processes (that) permit both insightful and foresightful behavior" (p. 3).

Social Learning Theory might help explain why children repeat what they see their parents do initially. It does not explain why children continue to repeat painful, unsuccessful behaviors over time and especially when they become adults and consciously vow never to act in ways they find themselves acting.

Social learning theory is a rational, reinforcement model. Bandura asserted that behavior is learned before it is performed and it is motivated by expected positive reinforcement before it is enacted (p. 8). Social learning theory seems to apply more to non-pathological identifications. Bandura observed, "Because people usually display modes of behavior that are appropriate and effective, following good examples is much more reinforcing than tedious trial and error" (p. 18).

With regard to pathological behaviors, Bandura emphasized that people inhibit behaviors when they see the model's actions punished. Conversely, they repeat the model's negative behavior when the model doesn't appear to experience any adverse consequences (p. 11). This adaptive, rational view of modeling doesn't explain why alcoholics drink themselves to death after watching their own parents drink themselves to death. Or it doesn't explain why parents beat their children, lose custody, and destroy their marriages when their abusive parents endured the same negative outcome a generation earlier. According to Bandura, modeled behavior that has obvious negative consequences would be avoided in the learning process.

As a rational, reinforcement model, Social Learning Theory doesn't account for why the delinquent children that Fairbairn described called themselves "bad" while describing their parents as "good" or "normal." It doesn't explain why adults abused as children often forget the negative experiences they experienced as children, while idealizing the memory of their parents.

Forgetting hurtful parental behavior contradicts Bandura's presumption that observational learning requires not only awareness of the parents' behavior, but remembering it as well. In reality, people often repeat pathological behaviors without remembering what their parents did and then without getting positive reinforcement. Not remembering and failing to get positive reinforcement not only occur but are often essential correlates of pathological identification.

Bandura's social learning theory doesn't account for the role of repression or forgetting events that occurs in pathological identification. It doesn't address the role of guilt and self-destructive behavior. It doesn't speak to the strong pull to protect dysfunctional parents that can lead the child to reverse roles with the parent, self-sacrifice, and self-blame.
(To be continued.)

References

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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.

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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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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.

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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.

46. -------- "Remembering, repeating and working-through," (1914), In the Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 12, translated and edited by Strachey, Hogwarth Press, London, 1958, 147-156.

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

SFPRG has offices coming up for rent. Now is your chance if you ever wanted to have an office in a beautiful national park! 5 year lease. Contact Rob in the office if you are interested. 415-561-6771

Our Membership Drive is ending. If you have not yet renewed your membership, please do so now! The profiles on our website of those who have not renewed will be deleted in September. Go to sfprg.org to renew or join today! Thank you!

SFPRG member Colleen Russell is looking to sublet one day a week in an office that can hold a small group of 8 people. If you know of anything please contact her at crussellmft@earthlink.net

SAN FRANCISCO CENTER FOR PSYCHOANALYSIS in conjunction with University College of London & Working Party of Comparative Clinical Methods CONFERENCE ON UNCONSCIOUS PHANTASY

To Register: www.sf-cp.org/unconscious-phantasy
September 28-29, 2013

University College London (UCL) Department of Psychoanalysis conference on Unconscious Phantasy, will be presented via video presentations and live discussions with prominent psychoanalysts from London presenting theoretically and clinically rich papers. The papers and live video link will be followed on Saturday by small clinical case conferences of a psychoanalysis focusing on the phenomena of unconscious phantasy.

Speakers Catalina Bronstein, M.D. Fellow and Training Psychoanalyst British Psychoanalytical Society.
David Bell, M.D. Training and Supervising Psychoanalyst of the British Society and past-President.
Michael Brearley, Ph.D. Fellow of the Institute of Psychoanalysis in London, recent past-President, and currently Chair of the Section for the Application of Psychoanalysis.
SAN FRANCISCO CENTER FOR PSYCHOANALYSIS 444 Natoma Street, San Francisco (415) 563-5815