Let's Agree To Disagree

• A Different Slant on CMT, Part II by Vic Comello, 11/27/98
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    • Different Things by Vic Comello, 12/12/98
      
      

My response in reading Vic Comello's response is "Let's agree to disagree." I value alternate views of the case of Kathy. I valued the participants views at the Feb '96 Case Presentation, as well as Stolorow's and Sampson's views, as well as the views of case conference participants responding to my Behavior OnLine presentation between Feb and July '98. I value multiple points of view and do not believe than any one theory has "the correct" view of a psychotherapy.

I am, however, a strong empiricist. I do take the patient's responses to my interventions (both immediate responses and long-term responses) as the "ultimate" criterion. Kathy had the most successful treatment outcome of all the therapies of the Berkeley Psychotherapy Research Project at UC Berkeley, headed by Professor Enrico E. Jones. (See Jones, E.E.; Ghannam, J.; Nigg, J.T., & Dyer, J.F.P. 1993. A Paradigm for single-case research: The time series study of a long-term psychotherapy for depression. Journal of Consulting and Clinical Psychology, Vol. 61, 381-394.) This "outcome" was measured from multiple points of view (independent evaluator, patient, therapist, objective self report measures, and even independent clinical judges) before therapy, every 16 sessions during the 204-session treatment, post therapy, at 6 months follow-up, and at 1 year follow-up. And I currently am still periodically in touch with the patient after many years.

There is one area, however, where Vic Commello and I totally agree. We hate Control-Mastery formulations that reduce everything to guilt. Now, to the extent that I have fallen into the guilt-reductionism pit in my case formulation paper, I apologize. I never saw Kathy's dynamics as reduced to that simple view and if I lead any reader of my paper (which I obviously have) to believe I did, then please read my case presentation on Behavior OnLine. What a therapist DOES in treatment and what she SAYS SHE DOES in treatment can be different stories. To get to the "TRUTH," put away the formulation paper and look at the actual treatment. Look at what I said to Kathy. Look at my attitude toward Kathy. Look at how I describe my behavior with Kathy. And if all that fails . . . look at the videotapes of the therapy. In fact, Professor Jones' paper is a presentation of an empirical study he did on those videotapes, using independent clinical judges. Another interesting empirial study on the case of Kathy is by Professor Jones and his student, Nnamdi Pole. (1998. The Talking Cure Revisited: Content Analyses of a Two-Year Psychodynamic Psychotherapy. Psychotherapy Research, Vol. 8, (2), 171-189.

In closing I repeat: If my formulation appears to reduce Kathy's treatment to only the issue of guilt, please look for the "truth" in empiricism - what was actually said, what was actually done in the treatment. The aspect of Control-Mastery Theory that attracted me to that point of view 18 years ago, I found by sitting in on the endless and constant studies of verbatim transcripts - not what the therapist said she said, but what she actually said - and what the patient actually said - and so on. That empirical bias of Control-Mastery Theory (CMT) is the singlemost distinction of CMT from other psychodynamic theories (besides the other important distinction of CMT being a case-specific theory.) Thank you, Vic, for your "different slants."

• Disagree? by Vic Comello, 1/4/99