Psychotherapy Book Review/Comments

I just finished reading Transformative Relationhips: the control-mastery theory of psychotherapy by George Silberschatz.

First, I wholeheartedly recommend it to anyone interested in therapy or psychology, or has feelings and thoughts.  I believe it’s given me a much better understanding of psychotherapy as a whole and at least one aspect of its cutting edge.

The book relates a theory of how we acquire pathogenic beliefs and how psychotherapy works (and how it sometimes doesn’t work) to disconfirm such pathogenic beliefs, often resulting in an increase sense of safety for the patient.  This sense of safety (an often unconscious phenomenon) can then lead to further exposure and subsequent healing.

I feel that I’ve learned a lot from the book but also feel like I do when I read Ken Wilber books–a little (or a lot) in over my head and trying my best to understand, process, and recognize implications of what I’ve read.  Thus, I really have difficulty summarizing the book or the theory it posits, however, I believe the theory comes out to some degree in the comments below.

One reason I like the theory is that it leads to treatment which, like Naturopathic treament, is specific to the patient.  It doesn’t prescribe one method of therapeutic intervention for every patient, but rather gives a context within which to receive a patient’s case and then formulate a model which can be used to hypothesize corrective responses/treatment goals.  The therapist then has a framework within which to make attempts at intervention in a systematic way.  I’d like to argue that our Naturopathic philosophies similarly guide ND’s in making hypotheses about a patient and then having a systematic way for intervention, which is at the same time malleable to the patient’s needs.  Another similarity between the two is that neither approach lends itself well to the gold standard of randomized controlled experiments.  Still, there is considerable well-conducted case-based research to back the theory presented in the book.

The book had me contemplating other connections, this time to everyday life.  The theory posits that patients come with an often unconscious plan to disconfirm pathogenic beliefs.  This plan results in various kinds of testing of the therapist including both transference (i.e. treating the therapist as if they were your mother) and passive-to-active testing (i.e. being the mother and treating the therapist as the patient was treated in the past).  Both types of testing are in hopes that the therapist will act “proplan”, that is, the patient unconsciously wants the therapist to not treat them as they were treated in the past or in the case of passive-to-active testing, display proper responses such that the patient might see a new way to respond to similar situations in the future.  Another option is that the therapy happens in a more conscious way and the therapists’ interpretations help the patient change his views and behavior.

The above is very interesting because I do believe that there is a certain drive to adapt/grow/evolve and I wonder how this could lead us into situations in our everyday interactions that might aide this process.  I wonder about how we might select those we spend time with both in concordance with pathogenic belief systems but also in an attempt to magnify and by doing so disconfirm these.  Surely there are both drives to conserve the status quo as well as disrupt/overcome it.  This seems to be an interesting job for future social-dynamics research.

In regards to the proposed topic of this blog, I write about psychotherapy here for important reasons.  Simply stated, therapy can help you.  Most any ‘you’ that reads this could probably be better off from some amount of high-quality therapy.  There is a stigma against getting therapy, and also a stigma against therapists.  This book, to me, proves that they’re doing some good things, and I believe even healthy, conventionally-defined as sane people could really benefit from proper counseling.  Subtle forms of guilt or other hidden factors can taint our ability to be successful and enjoy our lives.

Thus, at very least being open to reading this book and starting to make theories regarding one’s unconscious world can be pivotal to increasing health and happiness.  We can’t all afford to see a therapist, which is why I’d recommend at least reading about it to increase awareness of these kinds of issues and hopefully find ways to better our interpersonal (as well as intrapersonal) relationships.

Journaling, I’ve found, is a helpful therapy-like habit, as is talking with friends–though only the first is reliably available.

In addition, as well as conclusion, awareness of the connection between emotional/mental dis-ease and physical disease continue to rise, and with this rise the importance of healing both aspects increase.  Even if your problems seem, and might verifiable be primarily “somatic”, it is, in many cases, worthwhile to consider how emotional patterns might contribute.


Extra side note, a tangent to the blog, but I just can’t help myself.  My other big interest is consciousness/spirituality/meditation.  At the very end of the book there is some mention of work of Harry Stack Sullivan.  I don’t think that Sullivan or the author of the book meant to bring my mind into the subject of spirituality/consciousness, but there were words here of the “personification of self”, “developing a self schema”, and my favorite, the idea that the therapist should be a “participant-observer”.

These statements point toward what a lot of meditation work seems to try to bring people to: a recognition of a self which is beyond the character with which we’ve erroneously identified.  Well, the main error being sole-identification with that self which is merely a cognitive collection of wants and sensations.  One might say that a whole is made where there are only parts.  Still, the view that the conventional “self” is false is only the under-represented side of the coin, the side least known conventionally.  What I like the most and find most fitting is the idea of being a “participant-observer”.  That the true reality, when properly trained to perceive it, consists of a participant or “small-self” (the “false” one) which is linked to an observer/awakened, buddha-mind/God-head.  It seems worthwhile to recognize/develop both (see author Ken Wilber for more on this topic).  Now that I’ve opened that can of worms, I’ll mischievously escape and let your participant-mind ponder it!


About Central Coast Integrative Medicine

Dr Dunbar is a Naturopathic doctor and massage therapist
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