[From Dick Robertson] (950902.2136CDT)
Welcome back on the net David. As usual you have made a major contribution
by offering a glimpse of your personal work, risking the kind of raking
over that one can get (ask Ed and Rick). And thanks to Bill Powers for
inviting my reactions to your case (I had just begun to work on it).
I want to address two issues here, which have been intertwining like the
double helix in the thread you started with your case discussion:
1) The application of PCT theory with practical life -
2) Your particular case with all its interesting ramifications.
I don't know how to keep these strings clearly separated so I won't try.
First a general comment about your case.
There have been some developments: ...
--The boy finds it somewhat easier to leave his parents. He can be
encouraged to take a bike ride over to a friend's house for a
limited period of time. When a friend comes over, and he is
involved in play, he allows the separation.
This is the goal you started with, (your first identified "RS,")
This is a case I am working on now. While some progress is evident in
some ways, the basic problem remains....[a 9 year old boy]
shows fear when parents leave him,
so I think you must be doing something right (many things, of course).
We can go in several directions from here. HOW did you accomplish whatever
you contributed that helped the child begin to tolerate more separation
from his parents? How did your knowledge of PCT contribute to your coming
up with whatever you did that helped? How did the suggestions you got from
PCT colleagues help you help the kid? How does PCT contribute to a deeper
understanding of (all aspects of) the case? WHAT can we learn about the
interaction between theory and application from the whole episode?
I personally like my first and last questions best. (I hope others will
continue to tackle some of the other ones, as they have already done it.)
Let me start with the first. Right here I'm in a position relative to you
that seems analogous to the one you might have been in with the kid to
begin with. That is, each of you started off displaying some behavior that
an observer (you, then me) had to make sense of in order to get involved
with it.
In my case your behavior was your description of the case, and your
invitation to comment on it. In your case it was the kid's actions in the
face of distancing by his parents AND a couple of other things that aren't
completely clear in the initial description -- his parents' dissatisfaction
with that behavior of his, and his and their perception of your role.
You might not have regarded the "problem" presented as the "real one" (I
often don't), but like a good clinician you accepted to begin with the
issue as presented by the customer. This is of course essential to
minimizing errors in your own RS for eating regularly, and I believe it is
also vital for the customer to perceive you joining him (them) in
perceiving the variable they are trying to control. This point was made
implicitly or directly, I think, in many of the comments you got from co-
netters.
Now as to your RS for your perception of the end of the case -- which I'm
guessing you formulated roughly at the beginning -- I presume it would be
something like hearing the kid say: "Gee, I don't worry about my parents
abandoning me any more, and I'm often glad when they leave me alone to do
what I want 'cause I know they'll be there when I need them..."etc. And
for the parents to say, "Dr. G. you have been wonderful, we don't have the
problem anymore and we're going to sing your praises all over the
community." (or the like)
You haven't said any of that directly, so I can only guess at your RS for
the case -- and my best guess comes from what my RS would be. AND HERE IS
THE FIRST PLACE WHERE I SEE PCT THEORY HAS A DIRECT APPLICATION. I don't
know of any other theory of behavior that emphasizes, as does PCT, that
since we all are built along the same lines one's best guesses for
preparing "the test" can come from oneself. (AND "the test" would be the
second application.)
The principle that -- in the absence of direct data, one's best guess about
another person's RSs comes from putting oneself in his shoes -- is held
informally in the lore of many clinicians, but all the theories of therapy,
except one, are formulated in classical Cartesian form -- describing the
customer from an external point of view. The one exception is that of Carl
Rogers. (see footnote below.)
But, let's get back to you at the point you first put your case on the net.
Either the kid told you he was unhappy with his condition, or you inferred
it by putting yourself in his place (thinking about the costs -- loss of
autonomy, parents' anger, etc.). Taking a simple-minded, literal
understanding of PCT I don't see any inconsistency if you had said, "Dear
parents, since you say Johnnie has a problem occurring when you disappear
from his sight, don't disappear, case closed." (PS=RS, ES=0)
But, you didn't do it, because it would have been lousy therapy. PCT is a
theory about the basic nature of behavior. I don't think it can be
directly applied to psychotherapy any more than quantum theory can be
applied to bridge building. But it can be resorted to in analyzing for
violations of "laws of nature" -- as formulated in PCT -- in particular
therapeutic moves that fail. It can even sometimes help predict certain
actions as destined to fail, in the hands of a clinician who understands
the nature of behavior. It can also be resorted to as a framework for
directing your attention -- to RSs, ESs, testing for CVs, recognizing and
hence not interfering with Reorganization when it appears.
However, working clinicians, I, and I think you, have to do our work by
saying things that come from our own RSs and PSs of the moment. Those
verbalizations have to be in "coin of the realm" to keep in contact with
the ordinary citizen. The verbal exchange can sometimes be speeded up
where you can teach the person PCT, as Ed does, but I have found that slows
down, or ends the process, with more of the people that I see than there
are those for whom it works well.
I would love to have a videotape of (especially) your first meeting with
Mr. 9-yr old. Since he continued to come to see you, and his parents
continued to bring him, and you later saw a reduction of the symptom, I am
confident that the majority of what you did could be analyzed by us into
terms that would show your actions were generally consistent with PCT, AND
promoted effective reorganization in the customer(s).
The reason I would love actually to hear just what you said, and the kid
said, and the parents said, and see your faces and body movements is that
for me personally that is one of the three ways I learn to say things that
I perceive as effective, that I had never thought of by myself. That is
also what I found most useful in the comments you received on the case.
There were beautiful descriptions (e.g. by Martin and Bill and all the
rest) of actual experiences that could come up in therapy that we will
recognize as positive when they happen in the future. We will then not be
tempted to interfere when they are happening because those who reported
them told us they had good outcomes.
The second place I discover new actions to try is from the "classical
theories of therapy" which I now always run through the sieve of PCT before
deciding whether they might even be worth a try. And the third way is by
extending what has worked for me - again as filtered through a PCT
analysis.
I notice that I have been saying, "You sure must have been doing good
actions, I wonder what they were," rather than "Why don't you try this, or
that...?" I have two reasons for trying to abstain from that. One is,
some fear of interfering with what you have been doing, that is obviously
so good -- although that is not a big fear, because it is clear that you
don't get thrown off your own track much by suggestions that don't fit.
The second and more important reason is that I am absolutely sure that I
don't know what you should do. If I were in the situation, it would look
different to me in some respects, they might be big or little. Besides
that the facts, necessarily meager, that you presented give me so much
material on which to project my own imaginings of the major RSs of the kid
and his parents. I would expect (from my faint glimmer of chaos theory)
that the first little divergence from the real RS of the kid would get my
imagined view of his perceptual field light years away out in the universe.
For example, you say,
He wants to not feel so uncomfortable when his parents leave him.
This certainly sounds plausible. But, did he say it, or did you infer it?
and if the latter, did you find a way to subject it to "the test?"
WAIT, WAIT, WAIT, don't say that it already meets the test because he kept
doing his action when they moved out of sight. I agree that you have made
your case that his major CV is "them in sight." But that, by itself, does
not show an ES in his FEELINGS.
I can imagine another RS driving that behavior: REVENGE. If that were the
case he might not feel uncomfortable when his parents leave, he might feel
excited, exhilarated. An excess of those feelings would, I think, also not
be pleasant, so in that sense, "uncomfortable" might still be an
appropriate word, until we get to, Does he want to be free of the feeling?
Maybe not. You have given some indications that he could have vague
"intrinsic system" errors which he could never conceptualize and symbolize
in words but which might leave him with a fuzzy sense of being
"instinctually shortchanged." (Freud's UCS?)
For instance, you said his mother seems cold, has characterized him as
socially dishonest (bullshitter), and his father might also fall short in
reassuring his security (pressure to excel in karate, problem with his own
temper) -- maybe the kid is right in sensing that his mother has impulses
to disappear from his life. (They might be kept in continual conflict-
paralysis by her own self-image RS as a decent person.) And his father is
no guarantor of security. If that were so, and he despairs of security,
then revenge might be an alternative RS coming out of the fixed endowment.
(That whole topic is another issue of course.)
[Sorry I have forgotten whom to credit among the other commentators for
also suggesting that the kid could be attempting to control a CV in the
"real world."]
Continuing the above speculations, if the kid's CV of parents-in-sight is
the HOW of a higher RS, like, show-them-how-bad-I-feel-by-doing-something-
that-drives-them-up-the-wall, that might only be satisfied by him
perceiving them discover HE FEELS AS BAD FROM WHAT I DO, AS I FEEL FROM
WHAT HE DOES. A mutual reconciliation, then, would be understood in PCT
terms as each desisting from the particular way of controlling their own CV
that causes the ES in the other's CV. (Familiar ground to Ed, Eh what?)
Why does he expect this? His parents act mad at him sometimes. He
doesn't think that he is worthwhile enough so that they would want to stay
around him. He doesn't feel well liked at school. Other kids act as they
don't know who he is after he has been in the same class for a year. He is
not sure that his parents love him.
Taking the view that the self-concept is an 11th order system, and forms
after many principles, strategies, categories, relationships etc. have been
built and are controlling CVs of more immediate, overt action, I regard the
kid's view of himself -- as basically unworthy -- as the result, not the
cause of his and his parents conflicting CVs. As you know, many child
psychologists and social workers have observed that the order of
development is: my parents don't like me, so I must be bad,
rather than the other way around. Once that self concept has been formed,
it sets RSs for lower orders that keep its ESs minimized, and we have the
vicious circle between kids and parents' behavior.
Even if the parents are so stressed as unconsciously to wish the kid didn't
exist, I wouldn't believe they intended for the kid to develop a negative
self concept, but once it did develop, and resulted in the behavior that
increased some of their own ESs, they had the ammunition to support the
development of further negative self image, as witness his mother's brutal
characterization of the type of human being she perceives developing there.
Yet to the extent their self-images contain some RSs as "decent human
being" I would expect guilt, as well as bewilderment as part of the
increasing conflict in themselves. Thus, I think Bill has a point
[From Bill Powers (950821.0840 MDT)]
I'd put it to the parents that there are
problems on all sides and that the only way to solve them is to deal
with the whole family. The child isn't the only one who's going to have
to change something. If the parents absolutely refuse to consider this,
then I'd change my whole approach to the child.I'd say, "Look, kid, it seems that you were right all along. If you want
to get along in the world you're going to have to do it without much
help from your parents. They love you but it doesn't look as though
they're going to change much. This is not going to be easy, but if you
want some help in figuring out how to do it, my business is helping
people and I'm sure we can work out something together. I know how you'd
like things to be, but if they can't be that way, then we'll just have
to figure out another way for you to be happy and get what you want out
of life. Just say the word after you've thought it over. It's up to
you."
But, again, I believe that you, as a good clinician, would or wouldn't
actually implement that according as you deduce what is necessary to keep
them coming back. For, continuing to work, as long as it is getting
somewhere, is more important than doing what would be ideal, if that would
end the work.
There are other ways of confronting that issue, even when you do analyze it
in that way. For example, I, taking hints from my early Rogerian training,
might respond to the mother's (hostile, angry ?) description of the boy
She thinks that her son is a " bullshitter ." He supposedly says things
just for effect. She thinks that he " has a mean streak " and some of the
other children are avoiding him which hurt his feelings. She also adds
that " the apple does not fall far from the tree " which refers to the
father I believe.
by saying something like, "You see him as pretty dishonest, huh, and you
feel he is mean?" When I reflect like that the other person usually either
says, "no, what I mean is..." and we get more information. Or, else she
might say, "Yeah, for example..." and elaborate. When it is the latter I
might keep reflecting until she says something like, "Well, actually, he
doesn't always bullshit, I remember a time when he was really sweet..."
If that happens, it might lead to a beginning of reconciliation. If it
goes in the opposite direction to where she actually gets to, "I really
hate him at times, I wish he would disappear...[then a little further along
I would expect, tears, and] "oh, I feel awful for saying that." That would
give me an opening to say something like, "You feel awful, you wish you
didn't have that feeling, huh?" I could see that as resulting in a little
lessening of conflict in herself, which -> relaxation which -> more
receptivity on her part to "I wonder if he evers feels that way about me?"
which -> "maybe we do something to each other."
I want to emphasize that I introduceed the above to show how I IMAGINE I
might proceed if my imagined perception of what I would experience were I
present when the mother said that were real -- all that to argue that there
is no one way to proceed; everyone of us would do it differently, and we
would all succeed if what we did was facilitative to reorganizing in either
the parent, or the child, or both.
That brings me to a discussion of the use of drugs in therapy. Again I
agree, in principle, with Bill in believing that human organisms have a
sufficient internal chemical factory to service all our survival needs.
But there are qualifications. The increasing evidence tends to convince me
that experiences can -> disturbances in internal chemistry such that the
natural balance is so screwed up that external aids might temporarily help.
With people who understand how behavior actually works, and hence will
allow more time for natural mechanisms to restore the balance, I think it's
worth the wait, but as I've already said, the first rule is to keep 'em
coming, if not to do so might result in something worse.
There is a psychiatrist named Peter Breggin (I think) whose claim to fame
is going around the country giving the message that all psycho-active drugs
are essentially horrible poisons, and hence whatever effect they have is in
the body's arousal to fight their attack. Makes sense to me but I'm not
that combination of physiologist, neurologist and biochemist to evaluate
his thesis adequately. But from PCT I get an implication that I don't
think could occur to anyone with any of the classical understandings. That
is that perhaps the mirror image of Breggin's insight might be that
sometimes poison can arouse a more vigorous reorganization in an organism
that for whatever reason has gotten into stagnation. [Recall your own
speculation on this in your chapter in the textbook, David.]
If interference with each other's CVs is the core of the problem, and
reconciliation means each finding other ways to maintain their highest
order CVs, then there seem to be two alternatives at the immediate
application level: 1) substitutions at the next lower level; 2) reorganize.
The one you seem to have chosen to try first seems to be 1). That is, you
proposed to mother that she enact affectionate actions. I'm not clear
whether you have made a judgement about whether that has been effective.
(But, something has been, as I've noted above.)
I believe I can understand where that comes from - in your original theory
roots in behaviorism. At the moment I can't decide whether that is or is
not consistent with PCT, or simply neutral in regard to PCT.
I think I know why I can't get perspective on this strategy. It is because
I personally abhor it, on the basis of ancient habits and beliefs coming
suppose.
This is in no way a comment on your use of it, because it might well be an
entirely different thing in your hands. In my earliest training
(Rogerian and Psychoanalytic) we were taught to think that when a person
"becomes healthy" they spontaneously show affection, use aggression un-
hostilely, etc., etc. Conversely, we were taught that to encourage a
person to go through the motions of behavior that is personally incongruent
heightens internal conflicts and -- in the case of caregivers toward
dependents -- can ultimately become schizophrenogenic.
Early behaviorism was described to me (and I believed that I observed it)
as naive and effective only with healthy people who had some little habit
that they wanted help to change. As time has gone on I have come to see
some behavior mod treatments "work" where longterm dynamic therapy had not
seemed to make a dent. And I am happy to have my externs in the rehab ward
use behavioral techniques to help patients form new habits that result in
relaxation of tension, raising of depression, enhanced cooperation with
physical and occupational therapists and all the rest.
When something really striking and interesting happens I enjoy trying to
think it through in terms of what reorganization went on at what level, and
what new lower order CVs were brought under control that satisfied ESs in
what higher order systems. But, most of the time my work, and my
supervision of their work, stays on the level of practicing relatively
routine actions that get acceptable results, without thinking into the
background at all.
I suspect that you have to do the same in your moment to moment work, but
having a different bag of tricks you approach a problem with different
routines -- at least until you hit a wall. Then, I think both of us (all
of us PCT clinicians) resort to meta-analysis which has us examining, "what
he said, did" "what I said, did," in terms of RS, PS, ES, and
reorganization; but it's often damn hard, isn't it? There are so many
possibilities, without sufficient hard data to eliminate many of them
definitively.
So keep the descriptions and comments coming, with DETAILS, DETAILS,
DETAILS and gradually I think all of us will get better practiced at
detecting when some action of one's own more readily disturbs, enhances or
is neutral with regard to, the important CV of someone with whom we want to
have good outcomes.
[Footnote: I mentioned my opinion that Carl Rogers was the one exception
among the classical therapy theoreticians who promoted seeing the world
through the eyes of the client as the best way to promote personal growth
(read: reorganization). The core concept of his basic theory paper was
that "a person deals with the world of his own perceptions" and that
mental un-health is basically a condition of incongruence between
(unrealistic) learned action-tendencies and felt un-symbolized experience
(read: conflict). He proposed that therapy is reflecting back to the
speaker the unsymbolized feelings that are contradicted by the results of
personally ungenuine learned action habits, so that they be recognized and
action modified in such a way as to reduce the incongruence.
I think that my way, at least, of drawing out Rogers' implication rendered
me prone to get excited and enlightened when Bill and the two Bobs came to
present their new "general feedback theory" at Rogers' shop in 1957.
Since then, I have come to believe that every therapist who gets real
results in at least some instances has an intuitive grasp of certain basics
that PCT has shown the basis for. Freud, for example, especially in his
early writings, keeps emphasizing that it's the patients' not the Dr's
goals that have to be satisfied, and the patient's way of understanding
things has to be honored, even if in the long run you hoped to see him
reorganize the unrealistic streaks in his views.]
best, Dick
···
From: David Goldstein Date: 08/22/95, 11:10pm...
From: David M. Goldstein, Subject: a psychotherapy case 08/20/95,
from my own earliest training in therapy, and my particular personality I