A Different Slant, Part IIA

• A Different Slant on CMT, Part II by Vic Comello, 11/27/98
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    • Does the difference make a difference? by Jim Duffy, 11/28/98
      
      

Having said that I will NOT now take the time to respond to Jim Duffy's post, I will now take the time to respond to at least some of his concerns.

Although I have certain reservations about aspects of CMT, it should be noted that I argue, time and again, that CMT is firmly rooted in fundamental truths about human nature. This was the point of my discussions of the presence of pathogenic beliefs in those who do not seek therapy and the prevalence of unconscious planning and testing generally, and will again be the theme when I turn to transference testing and passive-to-active testing. (Note also that in previous posts I indicated my general agreement with Weiss's theory of dreams.) What I am trying to say is that the concepts of CMT are not parochial constructs of relevance only to CM therapists, but that I believe that they accurately describe human behavior both inside and outside of the therapeutic setting.

I have indicated that I have nothing but praise for CM therapists' interventions, but do take issue with their focus on pathogenic guilt when more than that guilt is involved. Jim asks if it makes any difference whether you dress your interventions in developmental language or in an emphasis on guilt. The answer depends on what you mean by a difference. Will it make a difference in symptom remission? No. Will it make a difference in whether a symptom returns? Probably not. But these standard measures of therapeutic success are inadequate, I believe.

A therapist can actively help a patient only for a short time. Even if that time is measured in years, we are still talking about a small fraction of the time the patient has to live. During that short time, a therapist can only push the patient's psychic boat away from shore. It's then up to the patient to row on his own the rest of his life. I feel that a therapist has some obligation, therefore, to provide a patient with a way of looking at his journey that maximizes his chances of successfully dealing with at least some of the squalls that will arise.

What does this mean when a patient is troubled predominantly by guilt-related pathogenic beliefs? It means business as usual for a CM therapist--one must ever stay focused on the patient's primary concerns. What does it mean when the patient is troubled by more than just pathogenic guilt? It means dealing with each of those other concerns without attempting to conceptualize them all in terms of guilt.

How can it be that CM therapists successfully deal with non-guilt issues while relating them to guilt? The answer seems to be that non-guilt issues are regarded as mere impediments to a patient recognizing his deep-seated guilt. They are not regarded as potentially crippling influences in themselves, but are seen merely as hurtles to be overcome in getting to the patient's "real" problem.

Let me give you an example. Kathy was rejected by her mother and was used by her father, who demonstrated that he had no interest in who she was, but only in her being the kind of companion he wanted to have. As a result, she evidently developed the pathogenic belief that no one will ever become interested in who she is as a person. Her therapist dealt with this situation magnificently in terms of her actions. She aggressively kept Kathy focused on her goals and showed a great interest in her writing and offered continuing encouragement that she pursue her talents to the fullest.

Nowhere in the case history, however, was any recognition taken of this being an important problem in its own right, and never, apparently, was this discussed as such with Kathy. So what?

We don't demand that most people show an interest in who we are as persons, but do expect that of our spouses. Kathy's first marriage was to a man who demanded that she play the same type of a role she played when with her father. Kathy complied initially, but there is some evidence that later on she began standing up for herself in demanding that she be accepted for who she is. Her husband refused and divorced her. As Kathy's therapy began, she was to be married once again. I contend that it could have been helpful to her to see how her pathogenic belief participated in her marriage and how her growth as a person led to her divorce, by way of helping her with her decision to marry and warning her of potential problems afterward.

• I think I'm getting it... by Jim Duffy, 11/29/98
• Interesting Slants and Dialogues! by Polly Bloomberg-Fretter, 11/30/98