Dear Colleagues,

Marshall Bush and I are hosting a seminar on Research Applications to New Directions in Control Mastery Theory on Saturday morning, December 14, 2013 from 9 - 12 a.m. We will review the existing body of research of SFPRG and start to formulate research protocols for some of the new ideas that were presented in the last two seminars on New Directions in CMT over the last two months. For those who are interested in doing research, learning about research, or promoting research, please come. All of the participants who presented their novel theoretical ideas are welcome to see how we can start to define and test those ideas in a research model. We hope to meet at a frequency of approximately once per month. Eventually we want to develop a natural series of research studies to test CMT clinical and theoretical assumptions that would be available to suggest to dissertation students and senior researchers as well.

We are planning a series of conferences for the next year. Denny Zeitlin is offering aseminar on CMT and Couples Therapy on May 24th. Buddy Mendez, our colleague from Southern California, and I are offering an introductory all-day seminar on CMT at Concordia University in Irvine. We have been planning a conference in Southern California for a long time but we will make it happen for the first time on February 1, 2014. We are also hoping to have repeat CMT conferences in Portland, Oregon and New Haven, Connecticut. We would like to offer introductory or advanced conferences on CMT in any other places where there is interest. If any of you from areas outside the Bay Area would like to put on a conference about CMT alone or with our help, please let us know. We are very interested in supporting these educational opportunities.

Plans for the 27th International Conference on Control Mastery Theory are coming together for the first week of March, 2014, following a Saturday Introductory Conference on CMT and Plan Formulation. We are also exploring conference topics for the following fall, including possibly a day with Dan Weil on Couples Therapy, and a conference with Victoria Beckner on exposure therapy and its integration with Control Mastery Theory in the treatment of anxiety.

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

Steve Foreman

Hello Community,

We are only days away from Thanksgiving 2013. As we enter the season of gratitude, I am aware of the gratitude I feel for the relationships I have developed as a member of SFPRG. It has been 25 years since my first class on CMT taught by Robin Fine and Jessica Broitman. I'll never forget Robin saying that your theoretical orientation is like the anchor you hang on to while you are being cast about on the sea of the therapy. SFPRG continues to bring the theory to young therapists and I am grateful to still be able to pass along the knowledge that was given to me by so many.

The Education Committee is making plans for several upcoming trainings. We are working on a daylong training in Los Angeles February 1, with long time SFPRG member Dr. Buddy Mendez. We are also planning a daylong training in the fall on treating couples. Most of my energy is currently on planning the next Annual International Conference on CMT: March 3rd through the 7th with an introductory class on March 1st. As I mentioned in an earlier newsletter, we are trying something new this year. We will two advances classes of our core curriculum, Advanced Plan Formulation and Advanced Etiology; and How Pathogenic Beliefs are Formed. We will also be asking people to sign up in advance the workshops they plan to attend. Stay tuned for the full schedule.
Happy Thanksgiving!

The SFPRG Board of Directors is now seeking nominees to fill board vacancies. The following board positions are available: Chair of the Membership Committee, Chair of the Fundraising Committee, and 2 Members-At-Large. Come June 1, we will need a new Chair of the Education Committee and a new Treasurer.

If you would like to serve a 3-year term on our Board, you can recommend yourself to the Nominations Committee. You can also refer a colleague whom you think would be a good candidate. Contact Rob at sfprg@sfprg.org for more information.

This year's group of trainees is 16 strong. We have two new trainees from Norway joining us in January 2014. They will overlap for a few weeks but then Kirsti Skogestad and Thomas Kleppesto will return home to Norway.

John Snyder has helped the clinic move in to the electronic world. We are now using eRecords from CarePath.com for all patient charts, including the research protocol. John has been patient in helping the transition from paper onto the computer.

Carol Drucker and Jessica Broitman have revamped the training program this year. The first two months are all about the basics of CMT: first sessions, plan formulations, pathogenic beliefs and testing. On each of these topics Jessica and Carol lecture during the didactic hour and then there is a paired case conference that covers the same topic. Material from trainees' cases is used in the case conferences. This gives the trainees a chance to explore these concepts thoroughly. One of the lectures has been videotaped with the hope that the lectures can become an online training program. (It is not yet decided who will be able to access this program.)

Helga Fasching has also helped move the clinic into a more efficient future with her new administrative assistance this year. She has been working on streamlining communication between the trainees and administrators/directors. Through using SurveyMonkey, trainees now have the opportunity to give their feedback about their case conferences on Wednesday and didactic trainings within a week of the conclusion of a scheduled block of training/case conference. (Feedback used to happen at the end of the training year.)

The CAPIC Fair was held in San Francisco on November 1st. Helga attended the member meeting where CAPIC's activities were presented and discussed. Besides Helga, new interns Lindsay Durgan and Beth Mitchner represented SFPRG. Five students who all showed familiarity with Control Mastery theory visited the booth. Notification Day for people applying for internships is February 21, 2014.

With a group this large, we can use your referrals more than ever. If you have a referral, please get in touch with Jessica or Carol. We'll take good care with any/all of your referrals.

Part 7 appeared in the October, 2013 Newsletter

When the therapist makes the observation that the patient may be repeating his parents' problematic behavior, it can feel very threatening to the patient, who may feel attacked. Consciously, the patient may assume that he is like his parent, has to be like his parent, and is destined to be like his parent. William thought his sadism was in his genes. Hearing the therapist point out the parallel between the patient's and his parent's repeated negative behavior patterns, the patient may misunderstand and think the therapist is saying that the patient is and has to be just like the parent. Especially with more disturbed, borderline patients, merely pointing out that the patient is repeating a parent's behavior may leave the patient feeling accused of being just like the hated parent, often the patient's worst fear.

By interpreting a patient's pathological identification, quite the opposite, the therapist is trying to point out that the patient is not just like his parent but is acting like her. Furthermore, by this formulation, the therapist is trying to convey that the patient actually has the ability and the right to not behave like his parents. It is often initially incomprehensible to the patient that he does not have to act this way. The patient is so absorbed in his belief that he is a terrible person, and so motivated to not see the parent's role that the whole discussion can be scary and easily misunderstood. For that reason, it is important to go slowly and only point out the obvious.

The Narcissistic Patient. Robert was a wealthy father of three who grew up with a mother who treated him as an outcast. At family dinners, she seated him far away from her at the dining table. As a younger child, his mother was always late picking him up from school activities and then berated him if he complained. If he ever made her wait for him, she yelled at him mercilessly. When he was sixteen, his mother planned an exotic family trip to Africa. The day before the family left, she told him he had to stay home to take care of a younger sibling while she and the father took the older kids on the trip. The other siblings all agreed that Robert was the difficult kid. Even his father complained that Robert should try harder to get along with his mother. As an adult, if Robert ever complained about his mother being unfair, the siblings would wink at each other and say how difficult he was. What did he expect from his mother?

As a divorced father of three sons, Robert tried to be a good parent but he experienced his middle boy, Peter, as "the difficult kid." No matter what Robert did, he felt that Peter always found a way to defeat him. Robert tried to accommodate his son, but ended up yelling all the time.

Robert always respected his mother's impeccable taste. Her house was perfect. Manners at the dining table were hugely important. His mother would never take the kids to McDonalds or Burger King. As an adult, Robert never took his kids to McDonalds or Burger King. In a sweeping condemnation of popular culture, he announced that fast-food restaurants were below his tastes. He told me he went on a date with a woman who wore blue jeans and that was the last time he asked her out. She did not show enough respect or interest in dressing properly for a date.

Even though Robert complained that his mother put certain social conventions such as manners and styles above her connectedness with him, he did the same thing with his kids and his girlfriend. He struggled with his feelings of rejection from his mother but didn't realize how much of her behavior he had adopted. The most striking parallel was how he had targeted Peter as the difficult kid in the same way he was put in that role, even as an adult.

The therapy was complicated in that a lot of things were happening at once. Robert talked about his relationships with his kids, his parents, his ex-wife, his friends, and work. He also engaged in a very intense relationship with me whom he yelled at, criticized, rejected, and relied on heavily for many years of therapy. This was not a therapy where a few well-placed interpretations carried the day. Most of the therapeutic work took place in our relationship, and particularly in me tolerating his difficult behavior without rejecting him.

When patients treat therapists the way parents treated them, Weiss called this turning "Passive into Active" (3,17). Weiss thought that when the patient acted like the abusive parent toward the therapist, it represented adaptive passive into active testing in the service of the patient getting better. The technique for dealing with passive into active testing was described in detail elsewhere (17) but can be summarized briefly here as follows: The therapist should experience and even tolerate the noxious behavior the patient reenacts in the therapy that the patient originally experienced at the hands of the parents, without developing the same pathology the patient did. In this paper, however, I am focusing not on passive into active testing that occurs in the therapy but more on pathological identifications that go on outside the therapy and what the therapist can do to help.

In Robert's case, he was very distressed that he acted so badly in relation to his son or when he was haughty and demanding with others in his life. He was both relieved and threatened by the idea that he was repeating much of the behavior his mother enacted with him. He worried initially that I was saying that he was his mother. He didn't believe he had a choice and couldn't see that he could act any other way. Over time, he found it a useful concept that he repeated much of his mother's narcissistic, self-centered behavior as an homage to her. He held a longstanding view that everything in the relationship that went wrong was really his fault because he was the difficult kid and she was the perfect mother.

Over the course of a many year therapy, he was able to dramatically change how he related to his son. His own level of personal pain diminished almost completely and he felt great improvement in his relationships with siblings and at work. Most of the therapeutic change came not as a result of intellectual interpretations, but as a function of our relationship. He was able to talk about and reenact most of the difficult, damaging experiences in his life, both in the transference and with the roles reversed, in passive into active testing. Sometimes, he would leave my office and say, "How can you stand me? Aren't I the most difficult patient you have ever had?" My ability to stay in the relationship, to like him, to stay connected, and to not believe his worst beliefs about himself helped him disconfirm his own worst fears.

Understanding that Robert repeated his mother's destructive, abusive behaviors out of loyalty to her helped me avoid seeing Robert as the evil, hateful person he thought he was. Understanding the importance of pathological identification helped me read Robert differently that eventually helped him see himself in a different light as well. Even his "narcissistic" affectations, his focus on style instead of substance, his harsh judgmental and rejecting style was borrowed from his mother's repertoire of pathologic behaviors and attitudes. After a long therapy, Robert became a much kinder, more flexible person and parent.

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.

17. Foreman, S. A., "The significance of turning passive into active in Control Mastery Theory," The Journal of Psychotherapy Practice and Research, 5, 1996, 106-121.

SFPRG has an office for rent. Now is your chance if you ever wanted to have an office in a beautiful national park! We signed a 5 year lease renewal with The Presidio. Contact Rob in the office if you are interested. 415-561-6771 or sfprg@sfprg.org

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