Robert Roalef The Patient's Search for Safety: The Organizing Principle in Psychotherapy (56 KB)
http://www.controlmastery.org/docs/Rappo
Control-Mastery theory views psychotherapy as the carrying out of the patient’s plan to overcome dysfunctional behavior patterns, which are seen as adaptations to early, dangerous interpersonal situations. People maintain these adaptations because they fear that the traumas they were intended to protect them against would recur if the adaptations were relinquished. It therefore follows that, in order for the pathological adaptationsto be dispensed with, the person must discover thatthe dangerous situations no longer exist, and that it is now safe to act in healthier ways. An experience of interpersonal safety is thus essential to the patient’s purposes in psychotherapy. Not only does the theory see psychological safety as a requisite for change, but it is seen as the only requirement for change: The theory proposes that people are motivated to relinquish their pathology and that they will do so to the extent it seems safe to do so. Interpersonal safety is therefore both the necessary and the sufficient condition for psychotherapeutic progress.
- Robert RoalefI might be making a post / note soon on the conclusions you can reach when you combine Control-Mastery and Scott D. Millers work. For what its worth they are the most empirical resources in psychotherapy that I have been able to find. 40+ years of research and compiled studies to back them up. And individually they came up with the same conclusions.
As well.. they line up very well with anarchistic philosophy.
Control-Mastery actually lines up very well with "Helping Mode" in the Psychohistory- Psychogenic modes modell. The therapist serves as a helper or enlightened witness along the clients unconscious plan towards health.
Whereas more therapist-directed models of psychotherapy could be seen to be "socializing mode". The client should follow the therapist prescribed path towards health.
While in the therapist-directed mode allegiance is directed towards the method of therapy. A belief that "this therapy works!".. The therapy is responsible for your healing and you are following it as a map.
In the client-directed mode, allegiance is directed towards the Self and Alliance with the therapist. "My plan is working". Your unconscious is responsible for your healing and you are following your own map.
A subtle difference that might be complete nonsense.. especially if you aren't familiar with Miller's work.August 27 at 12:57am · · - Robert Roalefhttp://scottdmiller.com/?q
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Scott D. Miller handouts. I recommend What Works in Therapy and SuperShrinks. Both essential for any therapist or self-therapist.
The paradox in Miller's work is that the type of therapy used accountedvery little for the improvement in the clients. This includes all kinds of therapies from standard practice CBT or ACT, to things like TFT and EMDR...which are far less standard....
Yet... The therapists belief in the therapy, measured as Allegiance, was the 2nd most (3rd if you count metrics), powerful determinant in clients success. The therapists belief in what they were doing was responsible for 100% of the variance in multiple 40 year studies.
My theory would be.. that make NO sense.
So I propose that a therapists feelings of Allegiance are largely drawn from the therapists ability in forming Alliance.
The therapist mis-places what should be a belief in their own skills, into a belief in the type of therapy they are practicing. Their innate ability to bring feelings of safety and build an alliance with the client is the primary cause of their allegiance.
They think "This therapy just works!" when in fact it is their own skill that is responsible.
This could also explain the opposite. A therapist who was not innately skilled at building alliances would not have much belief in their therapy. "This therapy doesn't work well for me." Their levels of alliance building and allegiance would be correlated.
This could potentially solve the paradox within Millers work.
I feel like this could pretty strongly explain the paradox. I was told it was good enough to get me published if I decided to expand further and check to see if no one else had thought if it .... but that guest was a complementary guy :P
Another potential for why Allegiance is important could be the concept of anchoring. If a therapist continually uses the same method of building an alliance.. the repetiition could be a process of teaching the patient to self-sooth. However, Millers' work indicates allegiance is a belief in the therapy....but doesn't clarify from what i've read whether that indicates the therapy is continual.
My assumption for this theory to be correct would be that a therapist with a low-level of allegiance would be more prone to being eclectic and changing their approach often. This would potentially negate the anchoring effect of using the same method.
Either complete nonsense or brilliant addition to the realm of psychology :PAugust 27 at 1:09am · · - Robert RoalefThe paradox to me as well when you compare the empirical work from control mastery and Scott Miller....
Control Mastery lays out a protocol of sorts of understanding a patients actions and drives in therapy. But it doesn't lay out a particular approach to therapy as far as I can tell. It indicates that the patient has an unconscious map / plan to achieve health.. And it is the therapist job to help them along the route to psychological security.
The question I would have is whether a Helping Mode therapy that is client directed would fare better than a therapy that is Socializing Mode.. therapist directed and based on a plan built into the therapy.
Millers' work didn't test for this. And it could explain the lack of differentiation in efficacy between types of therapy...
Because the Form is consistent among most therapies. They follow a prescribed path of action or interpretation and fundamentally it is often the therapists job to lead the patient towards health.
Form trumps the content of the particular type.
The great question would be whether the FORM of therapy which differs in control mastery theory and to various degrees in other therapies (Carl Rogers' Client-centered therapy being another example)... If the degree to which the therapist is a Helper and not a Socializer is responsible for the degree of Alliance established.
The degree to which the therapist controls the clients direction could be the degree to which trust/alliance does not flourish. The degree to which a type of therapy conflicts with a patients unconscious plan for health could be the degree to which alliance or even allegiance is altered.
Oh. And an additional treat if you've read this far.
Scott Millers work found that anti-depressants prescribed by effective therapists were more effective than those prescribed by ineffective therapists....The therapists weren't giving any therapy...just prescribing the pills.
And as an interesting aside... you could say that historically the implementation of outcome metrics in businesses has been a newer development in alliance building. It is interesting that it may be following a trend in how to build alliance and request feedback. This is what I would expect from a Helping Mode parent vs. a Socializing Mode parent. And also interestingly it is heavily featured in Stefan Molyneux's Real Time Relationships.
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