CM's Therapeutic Process

I have struggled to understand the distinction between CM’s and my view of the therapeutic process. In the end, I remain unsure whether there is anything more involved than semantics. So here is a comparison in terms of my two-selves viewpoint.

I have said that a person has a real self and a wished-for self. The real self is derived from childhood and is real in the sense that it operates in the person’s behavior, whereas the wished-for self does not, except as the basis for some very tentative unconscious testing of the boundaries of the real self. The wished-for self expresses the person’s hope of being like other people, of having the same promise of a better life. It of course is in opposition to the real self, particularly with regard to pathogenic beliefs.

CM formulates pathogenic beliefs in terms of the person’s relations with his parents. That is, it interprets the negative feelings the person has specifically to this alone. My view is that the guilt and shame CM tends to talk about so much are real and are important influences in keeping a person from living a better life, but they are not primary; they are not at the core of the person’s problems. This should be clear simply from the fact that patients can talk about these feelings fairly readily. It would not be so safe to do so if these feelings were not somewhat peripheral to the person’s problems.

The person’s primary concern is not with his relationship with his parents, but with his identity and how this relates to the world at large. What I am saying is that one should examine the pattern of the person’s relationship with his parents and abstract from that a set of expectations that define the limitations the person fears will be placed on his life. To an extent I am saying the same thing Weiss does when he says that people overgeneralize.

With this said, I think that having a person focus on his relationship with his parents during therapy is a therapeutically wise strategy. It is something that the person can talk about, and it is intimately associated with the person’s core fears. So it does become an apt metaphor for the person’s problems.

Putting everything together so far, it may be that there is no divergence between the two views, only a semantic one, based on the tendency of CM practitioners to formally describe their theory using the same language they employ with their patients.

A person comes to a therapist’s office in conflict between two subjective views. Alone, without external reality to guide him, a person cannot decide between the validity of the real and the wished-for self. One of therapist’s task is to confirm the validity of aspects of the wished-for self so as to disconfirm the corresponding pathogenic beliefs operating in the real self.

There is no a priori way for the therapist to guess which pathogenic belief he should disconfirm first. The patient is, however, more ready to disconfirm some beliefs than others. Here again we come to another instance of wisdom in CM’s approach. The therapist takes his clues from the patient. CM talks of following the patient’s plan, which is not a detailed strategy, but rather a series of shifts in direction in reaction to the therapist’s interventions. It’s the therapist’s job to stay closely attuned to what is important to the patient here and now.

CM speaks of the patient testing the therapist in terms of a mixture childhood and parental behaviors. The former it called transference testing and the latter, passive-to-active testing. All a patient is really doing is exhibiting the only behaviors open to it under the circumstances in an effort to use the therapist as a model regarding how it should behave in the future.

If you want to elicit a learned behavior from a mammal, put that mammal in the same situation the learning took place (because neural nets are basically input-output devices). While in therapy, a patient is seeking rules to live by, just as he did when a child. This subjective similarity evokes childhood learnings in a relatively pure form, which makes the therapist’s reactions an especially clear-cut way to disconfirm hurtful adaptations.

CM theory seems to imply that therapist-patient interactions are primarily responsible for therapeutic success, yet it also stresses that the therapist play close attention to what is happening in the person’s life during therapy. So here again is possibly another instance of only seeming disagreement. The patient did not learn what he did when a child merely from his parents. He took what his parents taught and used it in the world outside, where it was seemingly confirmed, or at least not disconfirmed. By the same token, I believe, patient-therapist interactions serve only as a starting place, that the final battles are won or lost outside of the therapist’s office. Hence the wisdom of focusing on and helping the patient with interpreting things that come up in the patient’s day-today life.

I think that the wisdom of speaking with the patient about guilt and shame and such derived from his relationship with his parents extends only so far. One problem I see with it is tactical. A patient is ever eager to end therapy at the earliest possible moment, which comes when he can sense closure to the lessons being taught. By keeping the vocabulary of therapy the same throughout, CM may be giving some patients an out to leave therapy too early.

Caroline’s therapist divided her therapeutic process into three phases. An exclusive emphasis on her relationship with her parents is appropriate only to phase one, I believe. After that, the discussion should turn progressively more toward issues of personal growth. Perhaps this does take place in practice. I have not seen a discussion of the usefulness of such a shift, however, in Weiss’s theoretical writings. Neither does one find it in presentations of CM case histories.

• It's all in the Plan! by Jessica, 5/2/98