Gary is cooking!

• The Case of Gary II: Things become more complex. by Jim Pretzer, 9/11/97
  
  

Jim's work with Gary is an excellent example of good, thoughtful therapy. Jim's interventions and objectives are couched in cognitive terms but as I understand the case, the material would easily translate to the language of Control Mastery Therapy. It makes it harder to respond for the works seems to speak for itself. Gary is getting better. Jim is helping him to feel safe enough to examine the beliefs that have organized his behavior and the defenses he adapted to deal with his conscious and unconscious anxieties.

I will re-tell this therapy and its progression as Control Mastery Theory would see it. Gary has tested Jim for several sessions in order to find out if it was likely that Jim would retraumatize him in the ways that he has come to believe he is most likely to treated.

We were told that " he grew up in a family where a suspicious, vigilant approach to the outside world was explicitly taught by his parents both through their words and their example. In addition, family member had been physically and verbally abusive of him and each other throughout his childhood, and had frequently taken advantage of him from childhood through the present" Gary is likely to believe that Jim will be like all others and mistreat him. When Jim is positive and actively tries to help Gary achieve success in the world he is offering Gary a sense of safety that will allow him to let Jim see a deeper level of his concerns and problems. This is what people are calling his "paranoid" world perspective.

Control Mastery Theory doesn't emphasize the use of diagnosis except as descriptive terms to help one see what defenses a person has developed in order to cope with their life and experiences.This is the way in which Gary is working in the therapy and functions in the world. Gary identified with his families view of the world and out of loyalty and with few other options, complied with and internalized their actions and attitudes. It is the safest way to deal with his situation. It will be difficult for him to shift his defensive style of suspicion until he has reason to believe that Jim will act differently than he had expected.

We can see this shift occur as Jim sticks to a nonjudgemental careful approach with Gary. Jim tries to open the possibilities for Gary without humiliation or attack. Jim calls this improving Gary's self-efficacy. I agree but think of it as teaching him a new way to understand his anxieties, helping him to see what they were based on, how they were an important component of his adaptive defense system and then offering him the opportunity to try out new more successful strategies in the treatment and in a relationship with Jim.

In short when Jim was open to seeing Gary in the most positive light and teaching him to succeed, It allowed Gary to believe that it was possible that an other person could enjoy his success and competency which allows him to begin to shift his belief system. We would expect that this process would be difficult and anxiety provoking for Gary as he has had little experiences (due as much to his continuation of the pattern) of alternative scenarios.

I would want to help Gary see the connections to his internalized identifications with his family and how out loyalties and the lack of another model for attachment he has maintained the same relationships with others as he had with his family.

As the relationship and trust deepens with Jim he may continue to show and enact the pathology he was exposed to and carries. This will be an excellent opportunity for JIm to disconfirm his strongly help beliefs that have interfered with his life. I hope he allows himself the opportunity to do so although there is the danger that he will feel to scared and disloyal to allow himself to progress to fast or far. Jim's interpretation of such anxiety and guilt will help him manger these difficult periods should they arise.

• Well, Gary was cooking back sometime before 1990... by Paul Salkovskis, 10/9/97