Monday, September 6, 2010

How do you combine CMT, Scott Miller, DeMause, and IFS?


Control Mastery indicates that a patient has an unconscious roadmap toward health/happiness/security.

They use transference testing and passive-into-active (parents in action) testing... to recreate their traumatic experiences in a safe environment, testing for different ways they could have reacted, and different ways their parents could have treated them.

Anxiety increases as a therapist confirms a patients unconscious fear / test.  Anxiety is reduced as the therapist passes or disconfirms a patients test.

This is counter to the analytic approach (and what most therapies use IMO)  that it is the therapists responsibility to make the patient uncomfortable and anxious... and then to intrude upon their defenses and force them to stop.

The secret to me with Control Mastery Theory is that it is a Theory.  There is no real implicit methodology for how you go about therapy contained within it.  It does recommend going for a reduction of anxiety in your patients, and suggests ways in which you can measure this.  But overall it seems that it is very possible to plug in many methodologies and follow this theory of anxiety and testing.

How does this plug into Scott Miller's work?

Miller's work indicates that the primary variables in the success of therapeutic treatment are:  Measuring progress objectively, feelings of Alliance, belief in the therapy (Allegiance), and to a minuscule amount Methodology.

The results Miller has found detonate the entire field of psychology.... 
http://scottdmiller.com/sites/default/files/What%20Works%202010.PDF

"Meta-analysis of all studies published between 1989-Present comparing bona fide treatments for PTSD

Approaches included desensitization, hypnotherapy, PD, TTP, EMDR, Stress Inoculation, Exposure, Cognitive, CBT, Present Centered, Prolonged exposure, TFT, Imaginal exposure

The results:
•No difference in outcome between approaches intended to be therapeutic on both direct and indirect measures;

Seriously?  TFT is as effective as the heralded "scientific!" "evidence based!" Cognitive Behavioral Therapy?  Do you know what TFT is?   http://www.skepdic.com/thoughtfield.html

The theory behind TFT is that negative emotions cause energy blockage and if the energy is unblocked then the fears will disappear. Tapping acupressure points is thought to be the means of unblocking the energy. Allegedly, it only takes five to six minutesto elicit a cure. Dr. Callahan claims an 85% success rate. He even does cures over the phone using "Voice Technology" on infants and animals; by analyzing the voice he claims he can determine what points on the body the patient should tap for treatment. 



What gives?

If you were to plug this straaaange finding on methodology into Control Mastery theory.. you start to see something that makes sense.

Successful therapy works this way:  A client does something with a therapist in an attempt to feel safe.  They present the therapist with unconscious cues of how they acted as child prior to being abused, or how their abusers acted towards them as children.   The Therapist then needs to pass these tests by being secure, curious, and comforting.  

I see no reason that a therapist couldn't do this just as easily in TFT as they could in CBT.

Now the secret in IFS in my opinion is not in the parts model.  I've yet to really get indepth or see any empirical evidence that it is a real model of the mind.

To me the important focus on IFS is helping the client find his way into the mode known as Self.  

Even people whose experience is dominated by parts have access to this Self and its healing qualities of curiosity, connectedness, compassion, and calmness. IFS sees the therapist's job as helping the client to disentangle themselves from their parts and access the Self, which can then connect with each part and heal it, so that the parts can let go of their destructive roles and enter into a harmonious collaboration, led by the Self. IFS explicitly recognizes the spiritual nature of the Self, allowing the model to be helpful in spiritual development as well as psychological healing."

It could very well be the traumas being acted out in Control Mastery theory can be understood as different parts in the IFS model.  I'm not totally sure what the best way is to symbolize or conceptualize these experiences... but I do think building the Self as curious, connected, compassionate, and calm.. is of the up most importance of any therapy... and is ideally the traits being responded with during Testing.

Now how on earth does this relate to Demause?  I brief example is in order.
In my last post I was talking about how some therapies fit the Socializing Mode of interacting.  While other therapies fit the Helping Mode of interacting.

In the 1960s 3 of the major therapists in field sat down and had a session with a woman named Gloria.
Carl Rogers of Humanistic / Person-Centered Therapy.  Fritz Perls of Gestalt Therapy.  And Albert Ellis of Rational Emotive Therapy (precursor to CBT).

Fritz Perls - Gestalt Therapy   goto: 4:00 for them meeting.
Albert Ellis - Rational Emotive Therapy       goto 7:00 for them meeting.

Listen briefly to their introductions... And then their introductions to Gloria...

Which do you think would be the most effective therapist?  Based on the evidence presented above from Miller and Weiss (control mastery),  success in psychotherapy is a result of a patient feeling secure and relaxed.

My argument is that Person-centered therapies such as Rogers Person-Centered Therapy,  Schwartz - Internal Family Systems therapy,  or even Control Mastery (if you consider it a methodology)..  Are what you would see in interactions in a Helping Mode society.  You are helped to feel secure.  The path to your happiness is found within yourself, not within some methodology where you need to re-wire your thoughts.  Painful feelings and memories are dealt with compassion, empathy, and calmnness.  This is the universal recommendation in all of these therapies.

I contend that nearly all other therapies are Socializing Mode therapies.  You are a broken person, in need of being reformed by a particular philosophy or methodology.  Your perceptions are skewed, you are irrational.  In RET you are required to reassess your thoughts and feelings rationally.  There is no great importance placed on feelings of compassion, calm, or security.  I am less familiar with Gestalt but the practice remains the same from what I have seen.  You need to question your irrational parts and inform them of the reality.

These theories of the importance of methodology are clearly made false by the work of Miller.  The question I have is... Do you see a profound difference in the level of alliance and security in a Helping Mode therapy vs. a Socializing Mode therapy?  Based on the practices differing emphasis on security and compassion; and on Glorias reactions to the therapists... I think that is so.


Thanks for reading.  Thoughts are appreciated :)

4 comments:

  1. You asked me about this paragraph Straalvin:

    "This is counter to the analytic approach (and what most therapies use IMO) that it is the therapists responsibility to make the patient uncomfortable and anxious... and then to intrude upon their defenses and force them to stop."

    I am referencing my own reading in REBT and videos I've watched from Gestalt and other therapies.. As well it was said very clearly in an interview with Alan Rappoport on Control Mastery that the fundamental difference here is the approach to resistance compared to other theories.

    "So, the motivation for the healing process comes from the patient, that's what makes it so important, this drive for mastery is the idea. So that, in a lot of other theories, it's the therapist that does the treatment to the patient. The Behavior theory is certainly that way. Analytic theory holds that the patient is going to resist treatment, the old analytic theory, at least. The therapist has to attack the person's defenses, so there the patient and the therapist in adversarial positions in some way.

    But, the control mastery view is that we're allies. More than that, the energy for the treatment is coming from the patient, so that's a much easier position for the therapist to be in. They're not carrying the burden of trying to drag the person into health and the person is either resisting or inert. You know? But our view is that the patient's trying to get better, the therapist's job is to understand what they're trying to get better from and what their goals are and what they're method of getting better is and then to ally ourselves with that to help them along in the process."

    http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=23223




    This is what is known as resistance by a patient.

    . In the Freudian psychodynamic approach, this concept refers to the psychic force that the patient opposes to the bringing into consciousness of certain unpleasurable representations during treatment: the psychic force developed to maintain repression.

    http://en.wikipedia.org/wiki/Resistance_(psychology)

    It is also what would generally be considered different protectors in IFS. Managers and Firefighters.

    The question as to how a therapy approaches resistance is what determines its status as a Helping or Socializing therapy in my mind. Gestalt and RET think that a resistance should be countered via the methodology... Do your ABC's of REBT. Whereas the evidence from Miller and Control Mastery indicate that resistance is overcome as the alliance strengthens. That as you approach a resistance you (or a Manager in IFS) test to see if the therapist is safe enough to enter.

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  2. Oddly what I said about TFT being even with CBT could mean my idea about person-centered / helping therapies being superior is not the case. I don't like that answer and don't quite understand it yet.. but its very possibly the case.. and Miller's work indicates it to be so.

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  3. Oooops. That might be the wrong TFT.

    http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=28704&cn=91

    Transference focused therapy.. Might be the case.

    Suffering the same naming battle as EFT with woo-woo.

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  4. Nope. I think I was right. It seems that Transference Focused Therapy goes by TFP.

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