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PRESIDENT'S REPORT
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From Steve Foreman
April 26, 2014
Dear Colleagues
It is spring and there are many important developments at SFPRG. One involves the Clinic. The Clinic has been a huge success story at SFPRG. Developed by Jessica Broitman and Lynn O'Connor, first at the Wright Institute and now at 9 and 10 Funston, the Clinic has served hundreds of patients, taught scores of trainees, and served as an educational and clinical center for Control Mastery Theory. We are indebted to many in the Control Mastery community for supervising and teaching at the Clinic. Several in our group have played a central role in supervising and running the clinic including Michael Lowenstein, Marshall Bush, Molly Sullivan, Barbara Sapienza, Ginger Rhodes, Helga Fasching, Carol Drucker, our current Training Director, and especially Jessica Broitman, our current Clinic Director.
The Clinic has been a labor of love. Jessica has done a spectacular job securing the current location for the Clinic in the Presidio. She has tirelessly and brilliantly led the expansion of the clinic. With Jessica at the helm, the Clinic has trained psychologists, PsyD's, pre-docs and post-docs, MFT's, and MSW's, partnering with programs such as Smith College and the University of Bergen, who have sent many trainees to our program.
Jessica has announced that she is planning a transitional process to leave her position as Director of the Clinic. The Board has appointed a committee to define the job description for the new Clinic Director, to accept applications and review candidates for that position. This committee is chaired by John Gibbins, the current Secretary of SFPRG. John will make further announcements in the SFPRG Newsletter regarding developments in the process to choose a new Clinic Director.
Another important development at SFPRG is that I will be stepping down as board president after my term is over at the end of May, 2014. I have served two terms as president over the last six years. It has been an honor and a pleasure to lead SFPRG during this time. I will continue to be involved as the past-president, helping Susan Landes, who will be taking over as president for her first term on June 1, 2014. Susan was our first intern at the SFPRG clinic. I have known her for many years and invited her to join the Board, which she did, and then served as chair of the Education Committee for the past two years. When Susan leaves her post as Chair of the Education Committee, that role will be filled by Jack Maslow. Congratulations to Jack and to Susan.
I want to put in a plug for Denny Zeitlin's wonderful half-day seminar on Couple Therapy on May 24 and for Victoria Beckner and my conference on the Treatment of Anxiety Disorders on June 7. There is an important interplay between Control Mastery Theory and Cognitive Behavioral Therapy that has not been articulated before to my knowledge. I think this conference will be helpful to anyone treating patients with anxiety, an extremely common disorder. I hope to see you there.
See you next month.
Steve Foreman
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Education Committee
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Susan Landes, Committee Chair
Hello Community,
Spring is a time of renewal. A time when the plants and animals around my house in Auburn start to revive. We are seeing baby birds in the birdhouses on our deck, irises flowering in the flowerbeds, and Mom and baby turkeys wandering around the neighborhood. Spring is also time of renewal around SFPRG. May will be my last month as chair of the Education Committee. I am very pleased to announce that Jack Maslow will taking over as chair in June. Jack has been on the committee since I started and has been an important voice in the planning and implementing of our educational events. I'm looking forward to experiencing changes that will result under his leadership.
I have many fond memories of the conferences we have held in the last few years, the Trauma Conference, the Addiction Conference, the Conference on Therapy Outcomes, the Attachment Conference and the last four March Workshops I helped organize. SFPRG for the most part, is a volunteer organization and a labor of love to keep alive the vision and work of Hal and Joe. I would like to thank all the people who continue to dedicate their time to the organization especially my peeps on the Education Committee, Jack, John Gibbins, Steve Foreman, George Silberschatz, Jamine Ergas and Rob.Petitpas
By the way, don't miss our next educational events: on May 24th, The Challenge of Intimacy: Control-Mastery Couple Therapy with Dennis J. Zeitlin, M.D. and on June 7th with Dr.'s Steve Foreman and Victoria Beckner on, The Treatment of Anxiety, A Collaboration between Control Mastery Theory and Cognitive Behavioral Therapy: How Much to Push Your Patient. This will be the second time we have brought Victoria in for a conference to share the similarities in our theoretical models and to continue the discussion on how it is often in the patients best interest (a pro-plan intervention) to integrate other techniques into our work.
Susan Landes
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From The Clinic Director
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Jessica Broitman
It's spring time and I've been thinking about transitions. For the past 15 years, I have been deeply involved in the running of our wonderful psychotherapy clinic. As I look to my future, it is time for me to turn the daily operations of running the clinic to a new director.
Our sliding scale psychotherapy clinic is a center for clinical training and research. We provide mental health services to San Francisco, East Bay, and surrounding Bay Area communities. We also participate in research in a variety of areas related to Control Mastery Theory. The clinic is thriving with 15 interns and it is my hope that it will continue to do so. With the help of over 50 of you, we train students from all disciplines including psychology interns, MFTs, MSWs, and psychological assistants. Our goal is to help students gain skill and sophistication in working in a variety of treatment modalities and with a variety of techniques, determined by client-focused and case-specific assessment, treatment planning, psychotherapy process, and outcome research, all based on Control Master Theory. We have hosted interns from around the world.
A thoughtful transition plan will best serve our thriving clinic. With the help of the board of directors, we have created a plan to hire and train a new person to fill the role of Clinic Director. John Gibbons will lead a committee to pick a new director. I hope that many of you will be interested in running the clinic. It is a fantastic opportunity to train the next generation of control mastery therapists. John will post the job specifications and how to apply in the newsletter. If you are interested in knowing more about this 10 hour/week position, feel free to email me.
I have loved my involvement with the clinic and feel that I have learned as much as I have taught. We have trained well over a hundred new talented control mastery informed clinicians. In moving away from my daily role, I will continue to stay connected as a teacher and supervisor with this dynamic center.
Jessica Broitman
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Job Announcement
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John Gibbins
The Board is pleased to announce that we are seeking applicants for the position of SFPRG Clinic Director (CD).
Brief job description:
The CD is in charge of managing all aspects of the clinic, including daily clinical operations, training, trainees and staff, finances, referrals, public relations, and working with the board. This position is quarter-time (10 hours/week).
Qualifications:
Licensed California Psychologist with a minimum of 10 years postdoctoral experience
Recognized expertise and experience in Control Mastery Theory
Leadership, administrative and supervision experience consistent with the position
Ability to work with the CD transition plan approved by the SFPRG board
Application Deadline:
June 1, 2014
Application Materials:
Please submit your current Curriculum Vitae along with references to the Search Committee; email to sfprg@sfprg.org or mail to CD Search, 9 Funston Ave., San Francisco, CA 94129.
John Gibbins
Chair, Clinic Director Search Committee
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Clinic Report
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Carol Drucker
It is always remarkable to watch how quickly the training year goes. We are over ¾ done with the year and it does seem like we have just started. We have finished our recruitment for next year's interns. We had very few spots and are excited about 4 new interns who will be joining us. They are all PsyD students, one from Alliant/CSPP; one from Fielding and 2 from CIIS both of whom are bi-lingual Spanish. For the first time we will be able to offer therapy in Spanish. We are looking forward to welcoming them in September.
On May 21 we will be having our annual party to recognize our appreciation for all of our supervisors. It is our small way of thanking all of your for your support of the clinic. It could not run without you. So please join us so we can say Thank You in person.
Over the last quarter we have had many remarkable trainings. Thank you to Alan Rapoport who shares his work in audio tapes for the trainees to hear and discuss; Steve Foreman who talked about working with children; Molly Sullivan who talked about working with depressed patients; and Gena Castro Rodriguez a current trainee), an expert on culture and cultural awareness who taught about culture. We thank all of your for participating with us and teaching us all.
Carol Drucker
Clinic Training Director
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Upcoming Conferences
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Register Now!
Our next conferences are:
The Challenge of Intimacy: Control-Mastery Couple Therapy
with
Dennis J. Zeitlin, M.D.
Saturday, May 24, 2014
8:30 am - 1:30 pm. 4.5 CEs at the JCCSF
register now online
The Treatment of Anxiety, A Collaboration between Control Mastery Theory and Cognitive Behavioral Therapy: How Much to Push Your Patient
Victoria Beckner, Ph.D. and Steven Foreman, M.D.
Saturday, June 7, 2014
details on our website
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A talk given by Joe Weiss
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Part 3
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. This is the third installment continued from the previous newsletter. - Editor
Unconscious Mental Functioning
Our theory, with its concept of unconscious testing, assumes that a person unconsciously performs many of the same kinds of functions that he consciously performs. As the research of academic cognitive psychologists has demonstrated, a person unconsciously assesses reality and develops beliefs about it. Also he unconsciously thinks, anticipates, and makes and carries out decisions and plans.
A person also exerts control over his repression. He represses mental contents such as memories, motivations, affects, and ideas as long as he assumes that their becoming conscious would endanger him. He brings repressed contents forth when he unconsciously decides that he may safely experience them.
Psychopathology
As I already state the patient's problems are rooted in pathogenic beliefs. The patient acquires these in infancy from traumatic experiences with parents and siblings. These beliefs are about morality and reality. For example a patient whose parents failed to protect him developed the belief about reality that he was not going to be protected and the moral idea that he shouldn't be protected.
The patient's pathogenic beliefs may be extremely compelling. They are acquired very early in life at a time when the future patient considers his parents to be absolute authorities. The infant and young child has no prior experience by which to judge his parent's teachings and attitudes. Moreover, he needs them to survive and he must learn to adapt to them.
Our definition of 'beliefs' is broad. We count as beliefs verbal structures and also structures that are non verbal and that may never have been conscious. The beliefs of the infant and young child are not encoded in words. Stern (1985) refers to such beliefs as RIGS, that is, Repetitions of Interactions Generalized. Alison Gopnik (1999) refers to them as theories. Even after a person has developed language he continues to acquire non verbal unconscious beliefs.
Beliefs are almost always accompanied by affects. A person who believes that the world is a dangerous place is anxious and tense. A person who believes that he is likely to succeed is optimistic and cheerful. Sometimes the patient's affects lead him to his repressed beliefs. For example a patient first became aware through his anger to his parents that he believed his parents had mistreated him.
We refer to the mental structures underlying psychopathology as beliefs rather than fantasies to emphasize that they are about reality, and that they are grim and painful rather than wishful. Freud followed this usage in his discussion of castration anxiety. He consistently wrote that castration anxiety stems from a belief or conviction and not from a fantasy (Freud 1926, pp.108). The belief in castration as Freud wrote about it, is from our point of view an excellent example of a pathogenic belief. Freud assumed that the belief in castration is unconscious and that it may give rise to psychopathology and that it is acquired by normal processes of inference from traumatic experiences such as from castration threats and from the sight of the female genitals. Moreover the belief in castration is grim and not wishful.
Here are some common pathogenic beliefs:
I am bad and unworthy.
Nothing I do will work out.
If I am strong, I will hurt my parents.
If I leave my parents, I shall upset them.
If I am demanding, I will burden my parents.
Anything I achieve is at the expense of my parents; therefore I should not achieve much. (This is the belief in back of survivor guilt.)
If I am friendly, I will be rejected.
The Therapeutic Process
Our theory of the therapeutic process follows from the above. It is the process by which the patient works with the therapist consciously and unconsciously to change his pathogenic beliefs and to pursue the goals forbidden by them.
The patient works to change his pathogenic beliefs by testing them with the therapist and by using the therapist's interpretations to learn that he suffers from pathogenic beliefs and that these beliefs are false and maladaptive.
He tests the beliefs by carrying out trial actions, affects or assertions that, according to the beliefs, should affect the therapist in a particular way. He hopes that the therapist will not be affected as the beliefs predict. If the therapist does not react in accordance with the beliefs, the patient may take a small step toward disproving the belief. He will also feel safer with the therapist. As we have demonstrated in our research, the patient reacts immediately after he experiences the therapist as passing a test or after an interpretation that the patient can use to counter a pathogenic belief.
1) The patient becomes less anxious.
2) He becomes bolder.
3) He becomes more insightful.
4) He experiences what he's talking about more fully.
In a recent study, we have shown that after the therapist offered the patient a helpful interpretation, the patient responded immediately, that is within seconds. His heart rate, skin conductance, his body movement immediately decreased. This response occurred before the patient reacted verbally to the interpretation. In some instances, after a short time the patient brought forth highly charged memories which confirmed the interpretation.
The Unconscious Plan
The patient in therapy works in accordance with a simple, unconscious plan which tells him in a very broad way which direction to go. It tells him which problems to tackle at any one time and which ones to defer. In making this plan, the patient as in making a conscious plan, takes account of many things including his strengths and weaknesses, his opportunities, his anxieties, and the personality of the therapist. In making the plan he is especially concerned with avoiding danger and retaining a sense of safety.
The idea of an unconscious plan seems counter intuitive to many therapists. However, as Miller, Galanter, and Pribram (1960) have argued forcefully, it is almost impossible to conceive of psychological behavior that is not done in accordance with a plan. The idea of unconscious planning applies to patients who seems to have no direction. Such a patient may be testing the therapist as a part of his working towards a particular goal. An example of this has been reported by Renik (1995) who, however, did not refer to the patient's behavior as testing. When Renik told his patient that she seemed to meander without purpose, the patient answered that she was attempting to assure herself that Renik would not impose his agenda on her.
The idea that patients are motivated to solve their problems is supported by evolutionary psychology. It is implausible that evolution would produce the kind of mind that Freud postulated in his early theory 1900, 1911 1950. A person with such a mind would be severely handicapped in his efforts at adaptation. He would be at the mercy of powerful shifting fluid unconscious forces over which he had little or no control.
Evidence of planfulness is supplied by infant research (Stern, 1985). According to Stern infants after birth begin to make and test hypotheses about their care givers in an attempt to learn how to develop a secure relationship with them. Their behavior as described by Stern is like the testing canted out by adults in therapy. The infants behavior does not depend on language or highly developed conscious mental life. The infant's behavior demonstrates that from the earliest stages of life the human has adaptive goals and works to obtain them.
We have found support for the plan concept from our own research. Here I'll simply describe our findings and not the method because a condensed presentation of the method would be difficult to follow in an oral presentation.
We found in numerous cases that interpretations that our judges assumed should help the patient to carry out his plan (referred to us as pro plan interpretations) tended in fact to help the patient to do so. After such interpretations the patient became more relaxed, bolder, and more insightful. However, the patient did not react that way after interpretations that our judges assumed should not help the patient in his efforts to carry out his plan.
Mrs. G.
I'll give a case example illustrating a patient's plan (Weiss 1986). Mrs. G. began analysis suffering from the belief that unless she complied with the analyst, she would upset him. She felt endangered by this belief. She feared she would feel compelled to comply with the therapist and so follow bad advice or accept false interpretations.
Mrs. G's father (and to a lesser extent her mother) had been perceived by her in early childhood as possessive and vulnerable. According to the patient, her father had been intensely involved with her. He had been pathetically eager for her to admire him and to accept his opinions even in trivial matters.
When Mrs. G disobeyed her father or disagreed with him even in small things, he would become upset. If sufficiently provoked, he would hit her. If not provoked to the point of violence, he would pout and become depressed. By the same token he would become overjoyed if Mrs. G went out of her way to express her admiration for him.
A vivid example of the kind of experience with her father that Mrs. G found so disturbing occurred when she was 6 years old. Her father had asserted that a horse never takes all of its hoofs off the ground even while galloping. Mrs. G responded by showing her father a photograph from an encyclopedia of a horse galloping with all of its hoofs off the ground. He became very upset, whereupon Mrs. G felt guilty about showing him up and went to her room depressed.
As a result of childhood egocentricity, Mrs. G had no doubt greatly exaggerated her power to affect her father. Nonetheless, her impression that she could greatly affect him either by asserting herself with him or by submitting to him was part of her psychic reality. It was from such impressions that Mrs. G had inferred two closely related pathogenic beliefs by which she governed her childhood relationship to her father: She believed that if she were assertive with her father she would hurt him, and that if she were submissive to him she would restore him.
At the beginning of the 150 sessions with which I am concerned, Mrs. G was in the throes of a father transference. She unconsciously regulated her relationship to the analyst in accordance with the pathogenic beliefs she had developed in her relation to her father. As a consequence of her unconscious image that the analyst was vulnerable, she was afraid to be either assertive or submissive to him. She feared that if she were assertive with the analyst she would hurt him, and that if she were submissive to him, or even too cooperative, she would fall into a masochistic relationship with him from which she would be unable to free herself.
Mrs. G's fear of submitting to the analyst was causally connected to her fear of asserting herself with him: Her knowledge that she could not comfortably disagree with the analyst contributed greatly to her fear that if she were to develop a close relationship with him she would be unable to extricate herself from it. She unconsciously feared that she would feel compelled to admire him, accept bad advice from him, and stay in treatment with him even if the treatment was of no value.
Mrs. G during the 150 sessions that are the subject of this report, worked unconsciously by testing the analyst (and, by the same tests, her pathogenic beliefs) in order to disconfirm the pathogenic belief that if she were assertive with the analyst she would hurt him. She tested the analyst, not with one grand test, but with numerous small tests. She began her testing by criticizing the analyst in a self demeaning way, that is, by being petty, mocking, or petulant in her criticisms. She apparently assumed that the analyst would be less challenged by such criticisms than by larger ones that were well thought out and delivered with dignity. For example, early in these sessions, Mrs. G spent part of an hour making fun of the analyst for having his name on the office door. She complained that its presence there exemplified his bad taste. A few weeks later she complained that the noise made by men working down the hall was disturbing her. She thought the analyst should ask them to stop working, and when he did not she accused him of being a timid "Caspar Milquetoast."
Mrs. G was anxious or tense while criticizing the analyst, and her voice became shrill. If, however, the analyst did not appear defensive, Mrs. G would assume that she had not hurt him and would relax. Moreover, she would remain relaxed for several sessions. While relaxed, she would be more cooperative. She would also bring forth new material, as, for example, new memories of having hurt her father.
Her plan for the opening phase of therapy was to reassure herself against this danger. She planned to work to disprove the belief that she was compelled to comply with the therapist. She tested this belief by disagreeing with the therapist and by challenging him. When he did not feel hurt, she felt better, gained confidence in the analyst and brought forth memories of her father's vulnerability.
She reacted in much the same way to the analyst's telling her that she was afraid of hurting him. She could use these interpretations in her efforts to disprove her pathogenic beliefs (we call such interpretations "pro plan interpretations").
In my opinion, she would have been upset by the interpretation "You are afraid to trust me". This would have been an "anti-plan interpretation". She would have experienced it as confirming her belief that the therapist wanted her to agree with him and so she would have felt endangered
After about six months of analysis, the patient became convinced that she could disagree with the analyst without hurting him. This enabled her to cooperate with him and to feel fond of him. She could feel safe in cooperating with him once she knew that she could disagree with him. Also, after six months Mrs. G. brought forth a sexual fantasy of being spanked by the therapist. She could express the sexual fantasy of submission when she knew that she did not have to submit.
to be continued in the next newsletter
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Bring a CMT conference to your area
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If you live outside of the Bay Area, SFPRG needs your help!
We want to present conferences on CMT outside of the Bay Area. Do you have connections with an organization that could either sponsor us or allow us use of a mailing list? We are APA approved so we can give CE hours anywhere in the U.S. If you know of an organization that would sponsor us, we can provide a lecturer; if you can get us a mailing list and leads on venues, we can do the rest.
Please contact Rob in our office (rob@sfprg.org) if you can help!
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Work in The Presidio!
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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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East Bay Office Sublet
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My Albany office will be available for rent in mid May. It is a lovely, peaceful office with a private as well as the main entrance, shared waiting area, 2 bathrooms, tiny kitchenette, call lights, and street parking. The building is a long established 'therapy' building on Carmel, steps from Solano Ave. I have several years left on my lease, so it is a stable rental option.
The office is best for couples, individuals or perhaps a small group. It will be available on Tuesdays, Thursdays, Fridays and weekends. I strongly prefer to rent to just one person, for a good portion of the above available time.
PLEASE FORWARD THIS to your colleagues. I would appreciate your help in spreading the word. Thanks!
Contact:
Lynn Watkins
415-648-8065
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