March 2, 2014

Dear Colleagues;

I have been corresponding with a new colleague from Pisa, named Luca Biasci, a psychiatrist and psychoanalyst. He knows our Italian colleagues Paolo Migone and Marco Casonato, and has expressed interest in using our research protocols with his patients and even representing and promoting CMT in Italy. His correspondence was so passionate and eloquent that I thought I would share a little of what he wrote in one email, with his permission.

Dr. Biasci wrote, "The point is that in many years of psychiatric and psychotherapeutic work with patients I have tried various models of work: the classical Freudian one, the classic Jungian one, the Kernberg's model and that of Robert Langs, but none, absolutely none of these has ever given the results obtained with the CMT. My results with the CMT are outstanding and I am so pleased to have abandoned almost everything that I used in the past (except sometimes the Jungian interpretation of dreams, which I think is useful) to the point that now I work however, in fact, quite as a therapist of SFPRG."

Dr. Biasci has published extensively in Italian journals on subjects as diverse as the psychopharmacology of cocaine addiction to psychoanalysis and Heidegger. I have sent him some research and clinical articles and connected him with several researchers in our group who are working on different protocols, (one who is a native Italian speaker). I have also set up some time to videoconference with him via Skype about research and clinical issues.

The reason I mention Dr. Biasci's correspondence and interest in CMT in this column is because it reminds me of a consistent experience I have had. People really find Control Mastery Theory useful and meaningful in their personal and professional lives.

I gave this year's Introduction to Control Mastery conference at the JCC on March 1. Some attendees were students without much clinical experience. Several said they had Control Mastery therapists and supervisors and felt understood and helped by them. Some didn't know anything about CMT but got a little postcard in the mail describing the conference and the theory and they thought it sounded interesting. There were over 25 participants in the room yesterday and everyone was actively participating, asking questions, bringing up other like-minded theorists they had read or were influenced by. Many had come to attend the entire week of the 27th International CMT Conference. People were moved by the theory and found it immediately relevant to their clinical work.

Jan Schreiber and I helped the group develop plan formulations on cases the participants presented. The first case was presented by a colleague from Davis, who works in a prison. She presented a man who was incarcerated for life after he brutally murdered a girlfriend 30 years ago for what he suspected was infidelity. His question to the therapist was, "How can you help me, when I am never going to get out of prison? What difference does therapy make?"

He didn't want to think about his life or explore his feeling because each memory was like another "horrible, slimy thing dredged up from a bottomless pit." But he wanted to talk to his therapist anyway, to deal with his overwhelming shame and remorse, and to see how he could tackle his pathogenic belief that he was a monster without a sliver of a redeeming quality.

We talked about what could be his plan. Perhaps it was to get clear about the horrible thing that he had done and to see whether it represented who he was as a total human being. Did he deserve any psychological redemption?

This man had a father who was terribly physically abusive and had beaten his mother savagely in front of him. Interestingly, his father beat his mother for the same reason that he beat his girlfriend to death. The father suspected his mother had cheated on him.

Does that understanding of the man -- that he might have been identifying with his father -- does that change our view (or his view) of him as a monster? It doesn't absolve him for what he did. He committed a crime and he is paying a price of life-imprisonment without the possibility of parole. That is not going to change. But we can start to see a way to think about this man as a human being with a psychology and a plan to come to grips with reality and perhaps even feel better about himself. What I like about CMT is that it even asks the question - What is the patient's plan? It is the only model I know of that has the concept of the patient's plan and it is crucially important in tackling a case that is as emotionally difficult and existentially perplexing as this one.

Dr. Biasci finds CMT very useful. Most of us who have had supervision or therapy from a CMT practitioner find it useful. We have seen how our students, our patients, even the parents of my child patients find CMT useful.

At the time of this writing, we are about to start a new week of teaching at the 27th International Conference on Control Mastery Theory. The experience I have had year after year is how useful people find the theory, and particularly the March Workshops where people meet so many of our teachers, who conceptualize and practice CMT so differently but still speak the same language. I have reported in this column before that many times I have heard students say they learned more in this week than they learned in four years of graduate school.

I wish you all a good week and I will talk with you again next month.

Steve Foreman

Groups are underway at the SFPRG Clinic!

We are excited to announce several groups and workshops at SFPRG! What began as way to help patients on our wait list has evolved to become a viable and exciting new treatment provided by the interns at our clinic. With the help of Carol and Jessica, and the supervision and help of Jack Maslow and Susan Landes, running groups has become an important part of the services we provide! Fees for attending groups and workshops are based on a sliding scale. Please think of us when referring your patients to groups!

DBT-informed Mindfulness Based Skill Building group
Facilitated by Camerin Ross, MA, and Joy Phillips, MFTI
Thursdays, 6:00-7:25; Next group starts in APril

Mind Over Mood: Change how you feel by changing the way you think
Facilitated by Ingrid Christiansen and Elida Austbo (Norwegian interns)
Mondays, starting March 17th, 5:15-6:45, 10 weeks

Hold Me Tight: A One-Day Couples' Workshop, March 30
Facilitated by Valerie Crawford, PhD, EFT certification-in-training, Camerin Ross, MA, and Joy Phillips, MFTI
Registration for this workshop is open! Please contact Valerie.Crawford@gmail.com

Looking ahead:
Post-doctoral intern Jodi Engstrom, PsyD, and David Becker, MD, MFTI are collaborating on a group for individuals ages 18-25 with chronic pain. Look for an announcement in the newsletter in the coming months!

Over the next few newsletters, we will present a talk given by Dr. Joseph Weiss on his work. We think this will be of interest to people curious about the development of Control Mastery Theory. - Editor

It's a great pleasure to be here, and it's an honor to talk to this illustrious group. I hope today that with the help of Paola Migone I will be able to convey to you my ideas about how psychotherapy works. My colleagues and I have been thinking about this question for 30 years and we sought answers to it in various ways including the careful study of cases, the reading and rereading of the process notes and transcripts of many psychotherapies including psychoanalyses. We have developed a number of hypotheses about psychotherapy, which we have now tested and refined by numerous quantitative, empirical research studies.

In our work we have been guided by two basic assumptions. The first concerns the criterion for evaluating the success of a psychotherapy. In my view the crucial criterion is "did the patient get better?" If the patient is satisfied by his treatment, and if he obtains and maintains desirable goals such as a good relationship, or a rewarding career, and a sense of well being, the therapy should be considered a success.

The value of a therapy should not be judged by the way that the theory was carried out. Thus if the patient is helped by a therapy, the therapy should not be criticized because it was not carried out in accordance with the tenants of a particular theory. As empiricists we should build our theories of therapy from the study of successful therapies rather than judge our therapies by theories which have not been empirically validated.
This brings me to our second criterion. It is that in our theory building we should attempt to test our basic construct by formal quantitative research methods. A concept which sounds convincing may turn out, when tested empirically, to be unreliable.

I shall begin my account of my theory of therapy by reporting how many years ago I began to develop my ideas. I hope in this way to make it more intuitively available.

I began by attempting to explain the paradoxical phenomenon of a person crying at a moment of happiness (Weiss 1952, 1971). This was a fortunate choice of topic. As will be seen, my attempts to explain this phenomenon made me aware of two important characteristics of unconscious mental life. These are that a person is unconsciously highly motivated to solve problems and also that he has unconscious cognitive capacities that enable him to work, often successfully, at solving them.

I exemplified the phenomenon of crying at the happy ending by the moviegoers who, while watching a romance does not weep when the lovers quarrel, but weeps when they are reunited. I assumed that the moviegoer is threatened by his sadness when the lovers are at odds and so suppresses it then. However, when the lovers are reunited, he no longer has a need to suppress it and so permits himself to bring it forth.

The moviegoer is happy when the lovers are reunited. Indeed, the reunion of the lovers removes all reason for him to be sad. Therefore, he may not realize that by weeping he is expressing an affect connected to the sadness he experienced earlier.

The moviegoer's sadness is not profound nor is it truly repressed. However, my explanation of the moviegoer's weeping alerted me to the possibility that a person at a particular moment of happiness may bring forth profound and deeply repressed sadness. Once alerted, I discussed this possibility with colleagues and friends who reported numerous instances of persons doing precisely what I had anticipated. I also observed this in my patients.

One such instance was told to me by Louise, a psychologist, who after becoming interested in my explanation of weeping at the happy ending, described in some detail her own experience of this phenomenon. Louise had lost a two-year-old son many years before. She was overwhelmed with sadness and so repressed it. Indeed, in repressing her sadness, she repressed the memories of her son to the point that she did not recognize him from his photo in the family album. Then, years later, she gave birth to another son and was overjoyed when he was brought to her room in the hospital. She immediately began to weep and to remember her first son. She remembered how much she had loved him and how sad she had felt at his death.

My explanation of Louise's experience was modeled after my explanation of the moviegoer's weeping. I assumed that Louise experienced the birth of her second son as making up for the loss of her first son. She no longer felt overwhelmed by grief at her loss, and so could safely bring forth her sad memories of him.

More Thoughts about Crying at the Happy Ending

This explanation raised a number of new questions. Why did Louise bring forth her sad memories as soon as she could safely do so? Just because a person is able to do something safely doesn't explain her doing it. Since she brought the sad memories to consciousness as soon as she could safely do so, she must have been highly motivated to bring them forth. But what was her motive? To me, the best explanation of her motivation was that she was seeking a sense of mastery. In order for a person to fully master a traumatic experience, a person must make it conscious. Louise was highly motivated to master the traumatic memories of her son's death. She did not like feeling in danger of being overwhelmed by sadness. Therefore, when she could safely bring the traumatic memories forth, she brought them to consciousness in order to put the memories in perspective and to dispel the sadness.

According to Louise, she brought the memories forth to gain a sense of mastery. She became able to think freely about an important period of her life that earlier she had avoided thinking about lest she become unbearably sad. As a result, she became more able to experience the continuity of her life. She compared her sense of freedom to the freedom a person feels who overcomes a fear of entering certain rooms in her house, and so becomes able to roam around her house at will.

Louise was definite in her rejection of the idea that she had not brought the sad memories forth because she felt guilty about being so happy. She stated that she did not feel guilty and that she greatly enjoyed mothering her new son.

Another question suggested by Louise's experience is as follows: What processes took place in Louise's mind in the brief interval between her seeing her newborn son and her beginning to weep and remember her dead son? Whatever did happen during this interval was not conscious. Louise was completely surprised by her sudden weeping and by her becoming conscious of the memories of her dead son. She experienced the weeping as interrupting a conversation she was having with the floor nurse.

Nor could the process leading to Louise's weeping and remembering have been automatic. It required unconscious assessment, thought and decision making. Louise must have unconsciously realized that the birth of her second son was precisely the change that would make it safe for her to become conscious of the sad memories of her first son. No other happy experience could have done this for her. Then, having realized that she could safely bring the sad memories forth, she decided to bring them forth and acted on this decision.

The experience that Louise reported points to the urgency of the wish for mastery. The emergence of the sad memories was powerful and preemptory. It took Louise by surprise and interrupted her conversation with the nurse. In addition, her experience points to the rapidity of unconscious mental processing. It was only seconds after Louise's new baby was brought to her room that she began to weep and to remember her first son. To what extent is a person who weeps at a happy ending aware of feeling sad? This depends on the extent of the suppressed, or repressed, sadness and the degree to which the sadness is resolved by the happy ending. When, as in the case of the moviegoer, the sadness is slight and is quickly and completely resolved at the happy ending most people are unaware of any sadness. However, several colleagues told me that even in this circumstance their experience is complex and contains a note of sadness. When the sadness is profound and not quickly and completely resolved by the happy ending, the sadness is readily experienced. Indeed, it may be the predominant affect.

Before continuing this history, I would like to point out that my explanation of crying at the happy ending parallels Freud's explanation of the emergence in dreams of repressed mental contents. Freud wrote (1900, pp.567-568) that, since while dreaming the dreamer is paralyzed and so cannot act on his impulses, he can safely experience in dreams impulses that he would consider dangerous in everyday life.

My explanation of crying at the happy ending also assumes the concept that Freud developed in his late writings of an unconscious wish for mastery (Freud 1920 pp.32, 35; 1926 pp.107). I had read, and perhaps without realizing it had relied on these Freudian concepts, in my own formulations. However, these concepts did not become alive for me until I realized that they made sense of an everyday phenomenon that I had previously considered paradoxical.

to be continued next month

Our next conference is:

Control Mastery Theory Couple Therapy
with
Dennis J. Zeitlin, M.D.
Saturday, May 24, 2014
9 am - 1:15 pm. 4 CEs at the JCCSF

A big thank you to all the teachers and attendees of the 27th Annual International Conference on Control Mastery Theory. The reviews show that attendees got a lot out of the classes that were offered.

The Education Committee is already discussing next year's conference.

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