September 15, 2013

Dear Colleagues,

We have just experienced two important events in the last week. On September 7, we honored Lynn O'Connor and Stanley Steinberg for their substantial contributions to Control Mastery Theory and the San Francisco Psychotherapy Research Group. Marshall Bush spoke about Stanley and Bill Meehan spoke about Lynn. Both Stanley and Lynn spoke affectionately about Joe Weiss. It was a lovely dinner with about fifty guests that included family, friends, colleagues, and students. I was particularly pleased that so many interns and former interns attended since they got a chance to meet major players who have made a difference at SFPRG while the older generation got a chance to meet the interns and recent graduates who will make a major difference in the continuation of SFPRG.

The second major event was the first of two seminars on New Directions in Control Mastery Theory. (The second seminar is coming up on October 19.) About fifteen enthusiastic participants, some experienced senior members of SFPRG and some students and young practitioners heard four excellent presentations. Steve Kanofsky gave a scholarly presentation integrating CMT with Narrative Therapy and Diana Fosha's Accelerated Experiential Dynamic Psychotherapy (AEDP). Steve talked about sharpening the focus on emotion and experience in the session. He showed a wonderful DVD of therapy with a patient, illustrating many of his technical suggestions including his focus on body sensation and emotional experience.

John Snyder presented his clinically based research on therapies at SFPRG's Clinic. He reviewed and had us all go over Intake Forms with a case example. He reported on the research data supporting the importance of therapists checking in with their patients on how attuned the patient feels the therapist is hour by hour. He showed us new iPads he acquired with a grant that will help us follow patient progress and record patient data electronically much more efficiently and completely. He reported some of the data he has recently presented at international conferences in Virginia and Australia.

Lynn O'Connor presented the span of her important work from the Interpersonal Guilt Questionnaire (IGQ) she developed with Joe Weiss and Marshall Bush many years ago to her recent work on measuring the salutary effects of meditation and the healing influences of Tibetan Buddhism. She emphasized the role of biology in addition to psychological factors in severe psychopathology. I presented some ideas extending Joe Weiss' work on Pathological Identification, emphasizing the role of repression and acting out when people repeat their parents' mistakes. See my current article in the newsletter on suggestions for technique.

People found the presentations very stimulating. I think it is important for young and older SFPRG enthusiasts to get together and hear each other think, question, challenge, and debate fundamental issues of theory. There were heated exchanges about the importance of shame vs guilt, and the role of trauma in psychopathology. I hope many of you can come to next month's presentations on October 19 when Joe Cristofalo will talk about substance abuse, Ginger Rhodes will present on trauma, and Heather Clague will develop her ideas about infants and pro-social behavior.

I want to encourage not only interns but experienced clinicians and especially those of you who are starting your practices to come to the case conferences given by Michael Lowenstein in the East Bay, Peter Schumacher, Norm Sohn, Alan Rappoport, and myself at SFPRG on Funston Street. These conferences offer not only excellent supervision and opportunities to get help with your difficult cases, but they also offer opportunities to meet other clinicians and network to get known and get referrals. My case conference on Wednesdays from 2:30 to 4 pm, starting October 2, offers an opportunity to follow a continuous case for the entire semester as well as trouble shooting other cases that we might follow for one or two weeks at a time. We have the opportunity to hear any case, no matter how difficult, with a wide range of patients including adults, children, and couples. We have also been reading research and clinical articles. I encourage you to come and attend a case conference. They are tremendous opportunities socially and professionally.

Finally, don't forget the Addiction Conference on Substance Abuse with Terence T. Gorski ,Susan Landes and Patsy Wood on Saturday, October 12. The next seminar on New Directions in CMT is Saturday, October 19. The Art Show is Saturday evening, October 26. There are many wonderful things happening next month. Don't miss any of them. I hope to see you there.
See you next month.

Steve Foreman

Ed Note: Paul Ransohoff sent this email to Marshall Bush as Paul was not able to make it to the fundraising Honorary Dinner on Sept 7th where we honored Stan Steinberg and Lynn O'Connor.

I wanted to speak about how he [Stan] was one of my first supervisors, both at Mt. Zion and at the Institute. How I felt he always seemed to have a clinical "green thumb," that lent a helpful perspective to me and my patient. And how his rich and full comments, which seemed to flow throughout our meetings, were invaluable. Many of his offhand remarks were more powerful than the home run swings of other teachers. In a world of many bright people who advertised their smarts, as well as many average minds who overvalued theirs, Stan stood out as that rare and precious combination of brilliance and humility, embodying penetrating insight with empathy and humanity.
He was and is a treasure of a man.

Thanks,
Paul

Photos from the dinner can be viewed here.

Hello Community:

Fall is here and once again it is a special time for teaching. I am delighted this year to be able to facilitate a case conference for the interns at the clinic. We have a large group of students new to the program and it is such a joy to participate in their learning. Our fall conference on Addiction is coming up soon. The conference is titled, Current Trends in Addiction Treatment; A Dialogue Between Terence Gorski and Control Mastery Theory and will be held at the SFJCC on Oct. 12. Check out our website for registration information. I hope to see many of you there! We are also in the planning phase for the March Workshop. If you are interested in teaching a workshop please let me know. Lastly, the committee is thinking ahead to spring and is planning to have a conference on couples work, possibly with an emphasis on Emotionally Focused Therapy. Stay tuned for more details.

In a recent conversation with several colleagues, one of my colleagues stated that most psychologists and psychotherapists are not that interested in addiction. Since I have spent most of my career specializing in treating addiction, I was left to ponder this statement. Why aren't more mental health professionals interested in working with this marginalized population? The answer is complex and too in depth for this short article, but in apart, the answer lies in the lack of training and the stigma of addiction.

In 2001 while researching my dissertation (The Development of a Graduate Training Program for Professional Psychologists in the Field of Chemical Dependency), I discovered what many of you have may have already known: that the assessment, diagnosis and treatment of substance use disorders (SUD) gets very little attention in graduate schools. Selin and Svanum (Alcoholism and Substance Abuse Training: A Survey of Graduate Psychology Programs, 1979) surveyed 107 American Psychological Association (APA) approved graduate clinical training programs to determine what courses, clinical experiences, and research activities were offered in the areas of alcoholism and other substance abuse problems. Responses from 74 programs indicated a modest level of research activity and clinical training, and that minimal course work was offered. They also reported that in clinical training, only seven percent of students received direct clinical experience in substance abuse treatment centers. In course work, all programs reported the substance abuse course work as an elective. The mandatory education was included as part of other required courses.

In a subsequent study of graduate training programs by Lubin (et al., 1984), with an overall response rate of 59% (out of 169 programs) and surveying both counseling and clinical programs, Lubin found "no discernable difference in quantity or quality of offerings (p. 151)" in the training of alcoholism and other substance abuse in either programs. As in the 1979 Selin and Svanum study, students across training programs receive only minimal training. Chiert, Gold and Taylor (1994) also surveyed graduate training programs in the area of SUD training. They stated that only 504 of the 68,000 psychologists whose names appeared in the APA 1989 directory identified substance abuse as their primary specialty. Moreover, in their survey of 95 clinical psychology graduate schools, only 11.4 % of respondents reported having an interest in working with clients with SUDs.

In 2011 (Mundon, 2012) only 54 out of 10,210 licensed clinical psychologists listed in the APA Member Directory specialize in the treatment of substance use disorders.

Today the average student receives 6 to 12 hours of SUD training through out their graduate school experience. While training across time has not improved much, the prevalence of SUD's has been on the rise, especially the use of opiates. SAMHSA (Substance Abuse and Mental health Services Administration) in its annual report for 2012, The National Survey on Drug Use and Health (NSDUH) produced the following results:

1. The rate of past month non-medical use of prescription drugs among young adults aged 18 to 25 in 2012 was 5.3 percent, similar to rates in 2010 and 2011, but significantly lower than the rate from 2009 (6.4 percent).

2. The rates of past month drinking, binge drinking and heavy drinking among underage adolescents aged 12 to 17 remained lower than their levels in 2002 and 2009. The percentage of people aged 12 and older who drove under the influence of alcohol at least once in the past year in 2012 was 11.2 percent, significantly lower than the level in 2002 (14.2 percent) but similar to the rate in 2011 (11.1 percent).

3. Overall, the use of illicit drugs among Americans aged 12 and older remained stable since the last survey in 2011. The NSDUH report shows that 23.9 million Americans aged 12 or older were current (past month) illicit drug users (9.2 percent of the population 12 and older).

4. Marijuana continues to be the most commonly used illicit drug. In 2012, 7.3 percent of Americans were current users of marijuana - up from 5.8 percent in 2007. Although past month use of marijuana rose in nearly every age group between 2007 and 2012, it did drop among those aged 12 to 17 from 7.9 percent in 2011 to 7.2 percent in 2012.

5. In addition to marijuana, the use of heroin also rose significantly. The number of people aged 12 and older who used heroin in the past year rose from 373,000 in 2007 to 669,000 in 2012.

Given the above statistics psychologists will be faced with the disease of addiction and may not be adequately prepared or willing address it.

In 2012 Dr. Chandra Mundon completed a powerful dissertation titled "Exploring Clinical Psychology Doctoral Students' Attitudes Towards Adults with Substance Use Disorders." One of the findings in her research was that individuals with SUD often evoked less compassion and more negative reactions in doctoral students compared to individuals with other clinical disorders. Mundon stated that it is possible that graduate students exposed to SUD in their first year practica and internships, compounded with inadequate SUD training and coursework, may have promoted feelings of frustration, incompetence, and a less empathic response to SUD clients. The substance abuse counselors that have done the majority of this work have long understood that people who are suffering with the disease of addiction are a marginalized, underserved population.

There have been many improvements in the way addiction is understood and treated. Control Mastery Theory has made a great contribution to our understanding of what can interfere with a persons attempt to recover. At the October 12 Conference we will be exploring CMT's contribution and will have the pleasure to learning from one of the masters of SUD treatment, Terry Gorski. I hope to see many of you there.

Chiert, T., Gold, S.N., & Taylor, J. (1994). Substance abuse training in APA accredited doctoral programs in clinical psychology: A survey. Professional Psychology: Research and Practice, 25, 80-84.

Lubin, B., Brady K., Woodward, L., & Thomas, E.A. (1984). Graduate professional psychology training in alcoholism and substance abuse. Professional Psychology: Research and Practice, 17, (2), 151-154.

Mundon, C. (2012) Exploring Clinical Psychology Doctoral Students' Attitudes Towards Adults with Substance Use Disorders. Doctoral Dissertation, Wright Institute.

Selin, J.O., & Svanum, S. (1979). Alcoholism and substance abuse training: A survey of graduate psychology programs. Professional Psychology, 12, 717-721

Mark your calenders for the Art Show & Auction on Oct. 26th! SFPRG members and friends will once again display their artistic side on Saturday evening 4-7pm, at a reception with wine and hors d'oeuvres. Some of the artists will have work to be auctioned, with partial proceeds to benefit SFPRG.

In previous years, we have been fortunate to have 2 portraits painted by Joe Weiss auctioned off; this year will be the last time we will auction off a Weiss painting and the first time to auction a still life (above).

We hope to see you at our offices in The Presidio on Oct. 26th.

Steve Kanofsky presented his ideas about how some of the concepts and methods of Narrative Therapy and Accelerated Experiential Dynamic Therapy (AEDP) might each enrich Control Mastery Theory (CMT) and Practice. In particular, he discussed three elements that are highlighted by these two theories: the Narrative therapy focus on integrating a cultural lens in case formulation, AEDP's focus on the accessing and expression of core emotional experience, and the emphasis within both theories on amplifying those times when clients are having success in overcoming their problems (or pathogenic beliefs in our language).

While Narrative therapy shares a common constructivist base with CMT in its emphasis on how humans develop a set of beliefs (or stories in Narrative language) in order to guide effective adaptation, Narrative therapists are generally more likely than CMT therapists to emphasize the influence of broader sociocultural narratives and forces in attempting to understand and transform a client's problematic beliefs/stories. For example, with some clients, addressing the oppressive influence of racism, sexism, gender socialization, homophobia, immigration history and/or social class status might be highlighted by Narrative therapists as either a painful reinforcement of family based stories or perhaps as the primary narratives limiting the client's preferred life directions (or unconscious plans). Steve discussed the case of an Arab American male, where an ability to shift the focus between family of origin based trauma and the sociocultural trauma of racism has been crucial in helping the client overcome self-shaming pathogenic beliefs developed in compliance with these oppressive sociocultural and family experiences.

In discussing an AEDP integration, Steve highlighted how many of our clients' pathogenic beliefs involve the perceived danger to themselves and the family system of acknowledging their core affective experiences, especially when there is a broader cultural and/or family context that tends to prioritize intellect and denigrate emotion. As emotion theorists and researchers highlight, warding off our experience of emotion in order to maintain attachment ties comes at the high cost of losing the adaptive action potential activated when emotions are processed to completion (e.g, the benefits of a "good cry," how accessing core anger leads to healthy assertiveness). For these clients, he suggested that providing the safety and encouragement to access and express core emotions is the most important work in passing clients' tests, and where some of AEDP's concepts and methods can be particularly useful in our efforts to be "pro-plan." For example, careful moment to moment tracking of somatic experience within the intersubjective field, including a focus on the client's (and sometimes) the therapist's awareness of emotion, sensation, imagery, and energy embodies a pro-plan attitude that helps many clients transform pathogenic beliefs about affect expression.

Finally, Steve discussed how both Narrative therapy and AEDP share a common emphasis on prioritizing and highlighting new experience that contradicts the problem focused story, pathogenic belief, or "working model" of attachment. In Control Mastery, this relates to what happens after we pass the client's tests, especially transference tests, or otherwise help overcome their pathogenic beliefs. In Narrative therapy, this prioritization involves the "re-authoring" of those "unique outcomes" that don't fit the problem focused story (and that also have a felt experience of emotional truth) into a more preferred narrative that more effectively guides the clients' adaptation going forward. In AEDP, this involves the therapist helping the client "metaprocess" new healing experiences (e.g. what it means and feels like for the client to successfully express previously warded off affects). In this regard, Diana Fosha, the architect of AEDP, noticed that when she began to focus on and experientially explore the process of transformation for clients, particularly what it has been like for the client to have a new experience in the context of a healing relationship with the therapist, that this exploration itself (metaprocessing) generally led to a cascade of further transformations that invariably included positive somatic affective markers. This included what she called "mastery affects" (the feeling of accomplishing something previously deemed impossible), "tremulous affects" (the simultaneous excitement and fear of accessing new capacity), "mourning the self" (a healthy grieving for what was once lost but has now been found), "realization affects" (the "wow" of new understanding and experience) and, eventually, what she called "core state" (a combination of increased compassion for self and others, a sense of calm, clarity, flow, "truth sense," and the clearest research indication of secure attachment: a coherent autobiographical narrative). In demonstrating these concepts in action, Steve presented some videotape work with an immigrant client who was able to access in therapy previously repressed aspects of her emotional/cultural self, previously deemed too dangerous to feel and express both within her family and a broader sociocultural context that shamed her for retaining native values and practices.

Metaprocessing this new therapy experience led the client to an increased sense of vitality, energy, and clarity that has since been translated into more joyful engagement with her native culture and a fuller emotional range. Steve expressed gratitude for having such a broad and flexible "home theory" that allows him the freedom to venture out and re-invigorate his practice of CMT with new models and methods.

David Bullard recently interviewed SFPRG member George Silberschatz for psychotherapy.net. You can read the interview here.

SFPRG has offices 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

OFFICE RENTAL JUST OUTSIDE THE PRESIDIO I have a beautiful office for rent Fridays and Saturdays. Located on Sacramento St between Presidio and Lyon. Please contact John Bogardus email: jblcsw1@comcast.net