Some notes on testing

If we should say which single concept may best differentiate CMT from all other approaches, probably our choice would fall on the concept of testing. Why was Weiss the only theorist able to identify the testing activity of patients?  As pointed out by Marshall Bush some years ago, it was probably because he was so clearly able to understand that our unconscious functioning is fundamentally adaptive. If we see our basic functioning as adaptive, we can try to understand the adaptive aims of our thoughts, emotions, communications, and actions even if they appear meaningless or “crazy”. And we should try to understand what patients do in psychotherapy according to this perspective.

What does testing mean? Tests are trial actions (unconsciously) aimed at disproving our pathogenic beliefs, at checking the level of safety of the interpersonal environment we live in, and at mastering the trauma which are the basis of our pathogenic beliefs. Testing means hoping that the trauma we experienced were not the only experiences we could have had, and that they were not deserved.  The testing concept also implies that our pathogenic beliefs are not the only possible truth about ourselves and the world and that we can find other people and other relationships to help us disprove them.  More generally, it implies that we want to get better, feel that this is possible, and basically that we know what we need in order to do so. The testing activity is intersubjective at its core, and it shows the implicit (and then explicit) ability to mentalize that human beings have since they are 10 months old (Murray, 2014).  I can test only if I believe that you can believe something different from what I believe.  From another perspective, testing is like devising clever scientific experiments by which we try as hard as we can to disprove grim, painful hypotheses that constrain our life.  However, this metaphor does not sufficiently take into account the pressure that we exert on the other person while testing, always with the aim of disproving our pathogenic beliefs. As scientists, we are not “neutral” at all.

Tests can be brief or longer lasting, mediated by actions, communications, silences, or attitudes.   Testing can be the primum movens of a specific kind of “acting”, while other times the testing activity functions as an “inner observing eye” carefully observing reactions to our enactments.  Although any communication or action can have a testing dimension, this is not inevitably the case because we can also simply behave according to our pathogenic beliefs, self-punitive motives, or efforts to adapt as best as we can to our environment.  However, we can be sure that testing is central when a patient stirs up in us strong emotions, pushes us to do something, or behaves in a particularly “absurd” and “excessive” way (Weiss, 1993).

Moreover, we all know that we can differentiate transference tests from passive-into-active tests, and we can also differentiate compliance tests vs tests by rebellion/non- compliance. We all utilize different testing strategies; most of us “select” one (or a few) favorite strategies and utilize it/them most of the time, which is one of the elements defining our “personality”; others may use a variety of strategies at different times for testing particular beliefs.  Finally, patients may test us simply by observation, in an effort to understand if our attitude, behavior, reactions and so on convey that we share their pathogenic beliefs – hoping, of course, that this will not be case.

The meaning of any patient behavior needs to be understood according to the pathogenic beliefs particular to that patient and activated in that specific situation.  Optimally, patients are best understood if we have developed an accurate formulation of the patient plan (Curtis, Silberschatz, 2007).  Moreover, similar behaviors, communications or attitudes may test different pathogenic beliefs at different points in therapy.  A case-specific plan formulation is typically the most useful guide to the therapist for understanding the patient and for passing the patient’s tests.

As a final note it is useful to keep in mind that in those moments where a patient seems to be most resistant or problematic, are the very moments where the patient is vigorously testing or working unconsciously to get better.  This point can be enormously helpful in our therapeutic work because it preserves hope and optimism exactly when they are most needed.

References

Curtis, J.T., Silberschatz, G. (2007), The Plan Formulation Method. In Eells (ed.), T.D., Handbook of Psychotherapy Case Formulation (2nd edition).    Guilford Press, New York pp.198–220.

Murray, L. (2014), The Psychology of Babies: How relationship support  development from birth to two. Robinson, London, UK

Weiss, J. (1993), How Psychotherapy Works. Process and technique. Guilford, New York.