What is a Test?

    Control Mastery (Broitman)
    • Tests by Don Nathanson, 1/15/97

    What is a Test?
    by Jessica Broitman, 1/15/97

    Don -thank you for raising some very important questions about the concept of testing. For those of you who weren't following the case conference discussion on BOL Don has been presenting an intriguing case. I recommend reading it to all! I am going to post part of my reply here and the part that is specific to that case at the case conference site. (Why I called Don's intervention a passed test)

    We believe that patients work consciously and unconsciously in treatment in many ways. Everything that happens is not a test and I agree with Don about the danger of over using a term. Therapeutic activities include many things. For example: patients bring in their own formulations, use insight developed either on their own or through their therapists interventions, remember and work through trauma, bring forth repressed memories when they feel safe enough to do so, and identify with their therapist's strengths and capacities. We believe that all these activities are in the service of helping the patient to reality check his or her belief system. He or she is asking among others the question- " are the beliefs upon which I have structured my life (so as to avoid dangers such as the loss of a love object or the love of an object) accurate? Is it still necessary to restrict my emotions, actions, activities, inhibit my goals, or be so guarded in my relationships?"

    A very important part of this (the patient's) work is accomplished through testing - similar to Freud's concept of trial action. We use this concept in place of resisting, acting out or in. It is very helpful in understanding the function of symptoms. The patient is seeking information in order to reconsider the reality basis for his pathogenic belief. These beliefs are central to his or her life and much of our patient's pathology is based upon adhering to these beliefs in order to avoid the dangers foretold by them.

    The concept of testing refers to the specific time when a patient is acting in a particular way with you in order to determine your reaction to the action or activity. The patient is particularly interested in your response to his or her behavior- sometimes even more than in really doing what they say they want to do- such as claiming to quit when they do not want to see if you will allow them to run away (this could be a rejection test). There are many ways to pass a test. It could include how you respond - what intervention or interpretation you make, or what action you do or do not take.

    This type of information seeking is not restricted to the consultation room. We all use this method in our normal relations in life. The difference is in part that a therapist is prepared to help the patient understand what he or she is trying to understand through their action and why. It is not always necessary to talk about or explain a test sequence but in some cases it can allow the patient to gain insight and consolidate his or her understanding.

    There are two kinds of tests- transference reenactments called transference tests and passive into active tests- where the patients take on the role of their parents. For more information about these tests please down load the primmer of Control Mastery Theory .

    The concept is particularly helpful when a patient is turning passive into active- these kinds of test are often painful, full of drama and counter-intuitive. They require the therapist to master a task that the patient could not when he or she was presented with the same or a similar task. Understanding why a patient is acting in such a difficult way can help you withstand the action and figure out how to best respond. I hope this can start us off on a discussion of the use and difference of our terms.


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