Interesting Slants and Dialogues!

• A Different Slant on CMT, Part II by Vic Comello, 11/27/98
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    • A Different Slant, Part IIA by Vic Comello, 11/29/98
      
      

The dialogue between Vic Comello and Jim Duffy is interesting and I appreciate it. As the therapist in the case of Kathy, which I presented on Behavior-On-Line earlier this year, I also value greatly Vic's "Different Slant, Part IIA." In fact, in February 1996 I presented this case at a conference for discussion by both Robert Stolerow,PhD and Hal Sampson, PhD. Although Stolorow's work was not then well-known to me, I had hoped that his Intersujective model would formulate an alternate view of the case of Kathy that focused on the development of her sense of self through her relationship with me in the treatment. During my work with Kathy, I was quite aware of the powerful therapeutic benefit of my intense and dedicated interest in her. And Kathy and I DID indeed talk about that interest and its importance in her growth. It is difficult to describe in writing all that occurs in a psychotherapy. The case write-up had page limits as did the published paper ("A Control-Mastery Case Formulation of a Successful Treatment for Major Depression" by Polly B. Fretter; In Session: Psychotherapy in Practice. Vol.1, No. 2, pp.3-17 (1995). For reprints, write me at PollyBloom@aol.com.). I agree with you that Kathy's sense of self was able to develop during treatment because of my ability to be vitally interested in her achievements. And Kathy also knew this. You can hear it in the letter she wrote me at the end of her treatment which was included in the presentation on Behavior-On-Line, duplicated in part here: "...You've done a wonderful job of keeping track of all of this. I once said how frustrated I've been throughout my life, feeling as though the people around me just didn't get the joke. Well, you did get the joke and what a rewarding thing that has been for me...." Those issues of recognition are central in all my interventions, especially the first section of the presentation where she mentions achievements and then hides them and then I have to aggresively pursue them. The published paper has an excellent example of this in the section on How the Formulation Relates to Treatment Interventions. Due to copywrite laws, I am unable to copy from the article but am happy to send it to anyone who requests it. But the important element here is that all of this activity on my part was discussed in detail with Kathy. And it DID help her to learn to "row her psychic boat" in her life after therapy. And all of her feelings of being unable to "be in the spotlight" were all about her difficulties with recognition and achievement. Kathy and I also discussed, in great detail, her life with her first husband who replicated her pathological relationship with her father, who could not tolerate Kathy's achievements. We even further applied these dynamics to make certain that she was not repeating these patterns in her new marriage. Yes, these are very important elements of Kathy's therapeutic benefits. I couldn't agree more.

Now, I do think that the Control Mastery formulation adds a piece to the issue of recognition, that your so-called "developmental view" might not add. To grossly oversimplify, in order to make the point: the Control Mastery view, for example, might say that Kathy believed her achievements would hurt "the other," and therefore, she relinquished them; whereas, the so-called "developmental" view, for example, might say that Kathy believed that (as you say, Vic) "no one would be interested in her as a person" and therefore she did not deserve recognition and could not achieve. In this possible example, I do not think the Control-Mastery view would disagree with this possible "developmental" point of view, but we would add the piece about Kathy's fear of hurting the "other." Now, back to the conference where I hoped this "developmental view" would be demonstrated because I, too, saw it in Kathy's work. I did not know back then that Stolorow did not consider himself an offshoot of Self Psychology. I have read more of his work recently and now understand that to be true. I believe that this so-called "developmental view" might be reflected in the work of Estelle and Morton Shane. I am certainly no expert in the field of self-psychology, but from what I have read, I think that the Shanes might have focused on how Kathy's sense of self developed in her relationship with me because I WAS ABLE to give her the RECOGNITION she needed in order to develop herself. I agree with both of these views and have found your dialogue very relevant. And in terms of the conference, Stolerow did not talk about Kathy's sense of self developing in the treatment, but spoke about his 2 levels of "trauma." From his point of view (to grossly oversimplify once again): Kathy was traumatized by being ignored after her brother died, but what was even more "traumatizing" from Stolorow's point of view, was that no one ever repaired that injury. In other words, Kathy was forbidden from talking about her pain. So she was injured doubly: first, by being ignored when in need; and second, by being unable to talk about the pain and thereby receive a kind of "repair." My attentive listening and being with her feelings about her life helped "repair" her injuries. Anyway, thanks to both Vic and Jim for all their careful thoughts.

• Different Things by Vic Comello, 12/12/98