May 23, 2014

Dear Colleagues,

This is my last column as president of SFPRG. It has been a privilege and a pleasure serving two terms over the last six years. I have learned a lot about how organizations run, particularly during a transition from a founder organization to one that is more democratic and committee based. I have learned a lot about SFPRG itself. Despite the personality differences, quirks, and sibling squabbles that arise in every organization and certainly exist in ours, I keep coming back to the inescapable truth that you can't keep a good theory down. Control Mastery Theory inspires us to treat our patients and teach our students with compassion, fairness, and respect, all of which were modeled by Joe Weiss and Hal Sampson.

Many members of our group have made a significant contribution over many years to teaching, research, and administration. As president, I particularly came to appreciate what Jessica Broitman had done in her term as president and for many years before that. This has been a difficult but successful transition from Joe and Hal as leaders of SFPRG to the present. I am grateful for the hard work and dedication of many of our group who love SFPRG, who promote Control Mastery Theory, who teach, who do research, who supervise at our clinic, who treat patients at the clinic, and who support SFPRG as an organization.

I am happy with who we are as an organization. We are financially stable. We have passed a budget every year and we are in the black. Our Clinic is very successful. We see more patients and train more clinicians than ever before. The interns are very happy with their training. The record keeping process at the clinic has gone digital, thanks to the efforts of John Snyder and a grant he obtained for buying iPads for the Clinic. The Clinic is generating data that is being used to do process and outcome studies. There are several research studies underway right now and several more being planned by doctoral students doing dissertations using CMT hypotheses and data from our clinic. We have a new line item for research expenses in our budget for the first time last year and this year.

Our teaching program continues to be terrific. We have had landmark conferences on Outcome in Psychotherapy with Lou Breger and George Silberschatz, Attachment Theory with David Wallin, Treatment of Borderline Personality Disorder with George Lockwood and John Curtis, Treatment of Alcoholism with Terry Gorski, Susan Landes and Patsy Wood, Treatment of Anxiety Disorders from a CMT and CBT perspective with Victoria Beckner, Susan Landes and Ginger Rhodes and many more. We have expanded our teaching program to include conferences in Portland and Los Angeles, as well as continuing to collaborate with Hans Peter Broch and our Norwegian colleagues teaching CMT in Bergen, Norway, Capetown, South Atrica, Almagro, Spain, Havana, Cuba, and other international sites. We continue to offer a complete and compelling International Conference in March that draws excited and loyal participants from all over the country and the world who want to come back year after year.

In the past five years, we have launched our first real fundraising program. It has started small but we want to get our name and our mission out to the public. As one of our consultants said, if we have a program that has value, we should be able to raise money for it. We have raised money for our clinic, our teaching program, and our research program. We have initiated a yearly fundraising dinner to honor those who have made major contributions to SFPRG and to CMT. We have started a yearly art show and party. We would like to increase our fundraising to expand our teaching program, offer stipends to interns, and eventually buy a building so we will have our own space that we can call our home.

Our membership has stayed stable over the past 5 or 6 years. We are making a concerted effort to reach out to Clinic interns to stay with the organization as members after they graduate, and help teach at the clinic, serve on committees and the Board of Directors. I am pleased to say that we have three former or current interns on the Board now, one of whom is poised to take over the presidency in June, SFPRG's first intern and president elect, Susan Landes.

One thing that became very clear, one can't run an organization alone. It takes a lot of people who are willing to share their ideas, their skills, their sane judgment, and their hard work to make this organization work. In the past six years, there have been 22 directors (not counting intern representatives and past president, Jessica Broitman) who have served on the Board with me. I would like to thank them very much. They are Peter Schumacher, Marshall Bush, Kathy DePaola, Carol Drucker, Karen Hubble, Norman Sohn, Molly Sullivan, Patsy Wood, John Curtis, David Auld, John Gibbins, Kathie Dunn, Rachel Rivers, Kasandra Burr, Jack Maslow, Harriette Grooh, Ginger Rhodes, Eric Taggart, Mia Salaverry, Susan Landes, Rachel Fierberg, Helga Fasching, and John Engstrom. I welcome any of you who are interested in participating in education, research, the clinic, membership, fundraising, finance, strategic planning, or any other aspect of SFPRG to call Rob Petitpas or Susan Landes and come on board. We need all the help we can get.

Thanks to all of you for your past efforts, your good wishes, and your future contributions.

Steve Foreman

As I take over as Chair of the SFPRG Education Committee, I want to thank Susan Landes for the great job she did in that capacity and wish her the best as president of SFPRG.

The education program is a key component of SFPRG, and we take pride in the range of high quality courses and conferences offered for our members and for the professional community. WE NEED YOUR INPUT AND INVOLVEMENT. If you have ideas for conferences or workshops that you would like us to consider, let the committee know. If you have an area of specific expertise or a unique perspective on CMT and would like to share your ideas with others, let us know so that we can help you set up a course or a workshop. Also, if you would like to be on the Education Committee and have a direct voice in the decision making process that guides our decisions. Feel free to email me at maslowJ@comcast.net with any suggestions or ideas regarding future educational programs.

We are currently beginning planning for the 2015 March Workshop, as well as developing CM courses for presentation outside of our immediate geographic area, as well as video and on-line presentations. There are two upcoming events which are particularly noteworthy. On June 7, Victoria Beckner and Steve Foreman are presenting a conference on "The Treatment of Anxiety; A Collaboration between CMT and CBT. For those who heard Dr. Beckner's presentation at last year's conference on trauma, you know that you are in for an interesting and informative discussion with these two highly skilled clinicians.

Mark your calendars for November 15th for our Fall Conference with Dan Wile, developer of Collaborative Couple Therapy, author of such noted books as After the Fight and After the Honeymoon and the man John Gottman calls " a genius and the greatest living marital therapist in America". Dan Wile's therapeutic approach is uique and highly effective, workshops are both instructive and entertaining. Dr. Wile will be joined by George Silberschatz for what promises to be a stimulating conference on CCT and CMT, presented by two clinicians both of whom have contributed much to our understanding of the therapeutic process. You will receive further information about this important conference over the next few months.

Again, we look forward to your input, and look forward to a successful year.

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

Joe Weiss said that when patients feel safer in therapy, they will deepen the therapeutic work, test more, become more relaxed and bold, and challenge their pathogenic beliefs. Contrary to many of his contemporaries, Weiss had a view of therapy that emphasized the patient's initiative and drive toward health and respected the patient's defenses. Instead of tearing the patient down and pointing out all their contradictory statements and provocative slips of the tongue, Weiss tried to figure out where the patient was trying to go and help her get there. Weiss developed a humanistic stance that honors the patient's plan and sees the patient as a partner in a process of getting better, rather than as a passive recipient of therapy.

But does this approach work with all patients? What about patients with Obsessive Compulsive Disorder who engage in ritualistic behaviors in order to feel safe? Or what about phobic people who avoid bridges or social situations in order to feel safe? Some in our group have raised questions whether the therapeutic techniques as practiced by many CMT therapists need to be refined in treating patients with significant anxiety symptoms. The critique of CMT with severely anxious patients is that if you wait for the patient to test conditions of safety to get better, the anxious patient may never do so. Anxious patients may engage in safety behaviors such as obsessions, compulsions, and avoidance, stay stuck, and maintain their anxious paralysis indefinitely.

This conference entitled "The treatment of anxiety, a collaboration between CMT & CBT: How much to push your patient?" is an attempt to address the issues of safety and safety behaviors. It acknowledges the contributions of Cognitive Behavioral Therapy, particularly the use of exposure therapy, in dealing effectively with Anxiety Disorders. It explores the surprising similarities between CBT and CMT including the role of pathogenic beliefs and how "exposure therapy" is actually an essential element of disconfirming pathogenic beliefs as practiced by CMT practitioners now.

While holding on to Weiss' concepts of promoting safety, this conference will discuss how therapists and patients can collaborate in challenging fears and pathogenic beliefs when the patient may be too stuck to initiate tests themselves. We will talk about the basics of CMT and CBT. We will present difficult cases to illustrate how severe anxiety can be another cause of patients failing to get better in addition to severe guilt, loyalty to dysfunctional parents, compliance, or pathological identification. Finally we will look at how therapists may need to push their anxious patients in a way that the patients experiences as safe and collaborative, to overcome pathogenic beliefs and attain a corrective emotional experience.

Please come to this novel and exciting conference and bring your friends, colleagues, and students.

Our annual SFPRG Membership Drive is underway! The support we get from membership dues is a very important part of our budget each year. This organization would not exist without our members providing the support that keeps us going. We are a non-profit with minimal staff. Membership dues, donations and volunteers are what makes this organization able to continue doing the important work that we do.

If you are not a member, please consider adding your support to those members who value Control Mastery Theory and our sliding-scale clinic. If you are a member, please renew as soon as you can so we don't incur any more cost in reminders.

You can join or renew online.

Thank you!!

Come to an afternoon of Painting and Friendship June 22, 2014 from 2-5pm at the San Francisco Center for Psychoanalysis celebrating the oeuvre of Stanley Steinberg with different painting groups and the deep friendships that formed within the groups.

There will be rare drawings by Sara Stein, a special presentation to Stanley by Japanese novelist Maha Harada of her recently published novel, Under the Sun and Stars, based on Stanley's friendship with the Okinawan Art Colony in Nishimui post WWII, paintings done with our beloved Estelle and Joe Weiss, and paintings with his current group, Presidio Art Group, formed after the SFPRG art exhibit in 2004, with current members Susan Yamaguchi, Helen Griffin, Elaine Myers, Pamela Hawkins, Stanley's daughter Anne Federoff, Jane Dulay and her son, Jono Brandel. To add to the festivities Wesley Ueunten, Professor of Asian American Studies at CSU, San Francisco will be playing the okinawan sànshin and Noriko Yoneyama, food editor for Japanese ladies journal will provide Okinawan and Japanese treats with of course, wine and sake!

A discussion with Stanley, Susan Yamaguchi, Maha Harada and Jane Dulay will share how creating art together can transcend seemingly formidable obstacles to form deep and lasting relationships.

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 fourth installment continued from the previous newsletter. - Editor

The Case Specific Approach

The therapist's approach and attitude to the patient are case specific. They depend on the therapist's assessment of the patient's particular pathogenic beliefs and goals and also the patient's ways of testing his pathogenic beliefs. For example, if the patient's primary belief is that he should be rejected, the therapist may be helpful if he is friendly and accepting. If the patient's primary belief is that he will be intruded upon or possessed by the therapist, the therapist may be helpful by maintaining a sense of formality and a relatively strong frame.

An illustration of the value of a case-specific approach occurred in the analysis of a patient presented below who experienced his parents as failing to protect him. He developed the belief that he did not deserve protection; he gave the analyst a powerful protection test; and he brought forth new memories of being unprotected after the analyst passed this test.

Dr. G.B.
The patient, Dr. G. B., was the only child of immigrant parents. He came to analysis after a previous analysis had failed, because, as the patient explained, during treatment he had become irresponsibly promiscuous. However, he added, he had learned his lesson and would not let this happen again.

Dr. G. B. complained of difficulties in his career and marriage for which he took responsibility. He thought of himself as battling a tendency to be self-destructive. Dr. G. B. remembered little about his childhood. However, he contrasted himself with his parents, stating that whereas he was highly educated his mother could scarcely read and his father had not finished high school. He felt guilty that he used his parents' scant resources to achieve a much higher station than they.

Not surprisingly, Dr. G. B. became promiscuous a short time after starting analysis, and he was so indiscreet that he was threatening his marriage and his career. The analyst assumed that the patient was behaving self-destructively in order to determine whether he (the analyst) would try to protect him from his self destructiveness. The analyst did try. He repeatedly told the patient that his promiscuity was self-destructive and that his continuing it was dangerous. The patient would listen carefully to the analyst's comments, then assert that in his opinion his promiscuity was not a problem. Finally realizing that Dr. G.B. would not respond to his interpretations, the analyst told him that unless he stopped being promiscuous he (the analyst) would discontinue the treatment.

Dr. G. B. became angry, wept, and berated the analyst for not maintaining an "analytic" attitude. However, he then became calmer and stopped being promiscuous. A few days later he brought forth a memory of his parents failing to protect him: On a number of occasions while in the fourth grade the patient exposed himself in the school corridors. His teachers tried to enlist his parents' help in getting him to stop, but his parents did not respond.

During the next year of treatment it became evident that Dr. G. B.'s most fundamental pathogenic belief was that he had achieved his success at his parents' expense. He had become self-destructively promiscuous in order to destroy his success and thus to put himself on a par with his parents. He unconsciously assumed that his parents out of envy wanted him to fail, and he took their not stopping him from exposing himself as evidence for this. He had feared that the analyst out of envy would permit him to ruin his marriage and career and was relieved when the analyst made it clear that he would not.

In the case of Dr. G. B. the analyst could pass the patient's test only by use of authority. He forbid Dr. G. B. to be promiscuous. If the analyst in an attempt to be neutral or in order to protect the patient's autonomy had not used his authority, he would have failed Dr. G. B.'s test and the patient, as he later acknowledged, would have felt betrayed.

The fact that in order to treat Dr. G. B. successfully the analyst had to depart from a neutral approach recommended by the Papers on Technique (1911 - 1915) does not mean that Dr. G. B.'s psychopathology was more severe than that of patients who can be treated successfully by the 1911 - 1915 theory of technique. A patient's not being suitable for treatment by the 1911 - 1915 theory reflects the limitations of that technique rather than the patient's degree of disturbance.

Dr. G. B.'s analysis illustrates another important point, namely, that helping the patient to carry out his plan does not necessarily mean going along with his conscious wishes. Dr. G. B. unconsciously carried his protection test to the point that the analyst, in order to pass it, had to be confrontational and, in effect, issue an ultimatum. Dr. G. B. consciously became quite upset as though the analyst was forcing him to relinquish an important source of pleasure. However, his subsequent calmness and his retrieval of the memory of being unprotected by his parents made it clear to both analyst and patient that Dr. G. B. had a powerful unconscious wish for the analyst to use his authority to protect him from his self destructiveness.

As illustrated by the case of Dr. G. B. a patient may consciously object to an interpretation or intervention but by becoming less anxious and by producing new material reveal that the intervention was helpful.

Some analytic patients, especially during the opening phase of treatment, feel endangered by any interpretation. They assimilate the analyst making interpretations to a parent lecturing them, pulling rank, limiting their freedom, or giving them unsolicited advice. With such patients (and indeed with all patients) the analyst's first priority is to help the patient to feel safe. Therefore the analyst should refrain from interpretation or use it sparingly until the analyst receives some indication that the patient is no longer endangered by it. Until then the analyst may communicate by passing the patient's tests and by his overall approach. If the analyst helps the patient by non-interpretive means to feel less endangered so that the patient becomes less defensive and develops insights on his own, the analyst may add to the patient's developing self knowledge by providing the patient with explanations that help him to organize this knowledge. For example, if the patient brings forth a childhood traumatic experience, the analyst may point to the pathogenic beliefs he inferred from this experience and show him that he is still struggling to change these beliefs.

final installment to be continued in the next newsletter

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!

June 7: The Treatment of Anxiety, A Collaboration between Control Mastery Theory and Cognitive Behavioral Therapy: How Much to Push Your Patient

September 13: SFPRG Honorary Dinner Fundraiser November 15: Conference with Dan Wile (title TBD) December 6: Annual Art Show Reception and Auction

On December 6th we will hold our annual Art Show Reception and Auction. We are looking for donations for the auction. At last year's auction we had many great bottles of wine which folks had fun bidding on! If you can procure an item for auction, please let the office know. We are hoping for donations of wine, dinner certificates (ask your favorite restaurant if they donate to non-profits), vacation homes, tickets to shows (theater, concerts, sports), and of course, art. Anything you think would be a good auction item for our fundraiser, please donate it!

We would be happy to provide a receipt for tax records.

Note to artists - please think about what art you might like to show in December!