Thoughts on Vic's Questions

    Control Mastery (Broitman)

    Thoughts on Vic's Questions
    by Jessica, 3/27/98

    Thank you for giving us so much to think and talk about Vic. I hope others will feel free to jump into the discussion too!

    We see many factors influencing a patient's behavior during therapy. There are too many to enumerate but to mention a few : the patient's constitutional factors, fate, luck, the strength of their drives, temperamental matches between therapist and patient, goals that the patient has, insights that the patient acquires, strengths of the therapist that the patient can identify with, and the environment out of therapy, all play an important role in helping patients change. In all families children and parents have to face difficult developmental shifts which require everyone to take leaps into new relationships and test their capacities. Our patients come to us because there is something usually, that has gone wrong that has made this process more difficult for them to manage. This could be true for many different reasons including that their parents were uncomfortable with their desires to separate. When a child is confronted, by parents who appear to be troubled by her actions, she has to find alternative ways to fulfill her desires. The child must hide, repress or destroy her normal developmental process toward separation. Theses are the cases, like the case of Caroline (see the case conference for details), that we see in our offices.

    Caroline had an particularly difficult road to travel and went to unusual, extreme measures of self destructiveness, in order to deal with the particular circumstances of her family life. All families have to work things through, but not to the extent that Caroline did in her family. I am sure that Jamie talked frequently with Caroline about how normal and adaptive her desires to separate were. Patients usually don't need our help when families can handle normal developmental tasks. We must help our patients with the difficult issues that are based on their pathogenic beliefs formed from with in unhealthy environments or traumatic situations.

    We all need to form bonds and have our needs for emotional support met. I do not know what you mean by your question : Is psychological bonding accounted for by CMT? Do you mean accounted for as in valued and seen as important? We believe that one's desires to stay bonded are a central factor in psychopathology. We believe that one will create symptoms in order to stay connected to and protective of loved ones. I think you are referring to this when you say : Charlotte needed desperately to establish a barrier against them if she was ever to have an independent sense of self, but could not bring herself to consciously decide to cut them off.

    We completely agree that we are adaptive, planful beings. I missed the part of the case where Jamie encouraged Caroline to feel sorry for her parents. Parents often can not afford to feel sorry for their parents till they are very separate from them and can see the family situations in all their complexities clearly. There are those patient who feel too guilty about being upset at their parents and would need our help to not separate too much too fast so it depends on the patient. I agree with you that Caroline coached Jamie as to the best way to work with her and here is one of the many places that intuition comes in as we are picking up unconscious messages from our patients all the time.

      • Caroline: Introduction I by Vic Comello, 3/29/98
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