What happens when you pass a test?

Gasser reported on Weiss’s research, that as patients feel increasingly safe and lift their defenses, they then gain insight.  Along these lines, successful treatments are those during which the therapist is able to pass many of the patients’ tests and make pro-plan interpretations in order to increase the patient’s’ insights so that they may move toward living the way they would like, according to their plan.

The therapist has the chance, through suitable interventions and passing the patient’s tests, to help the patient in disconfirming some aspects of his or her pathogenic beliefs or moving towards his or her therapeutic goals. Previous research showed that when a therapist “passes” a test, the patient could make a therapeutic progress; if the therapist “fails” the test, the patient becomes more anxious and doesn’t show therapeutic progress (Silberschatz, Curtis, 1993). While testing, the patient monitors the therapist’s reaction to see if they disconfirm or confirm a pathogenic belief (Bugas, Silberschatz, 2000)

When the therapist succeeds in disconfirming the patient’s pathogenic beliefs, it increases the patient’s conscious control on these beliefs. If the therapist fails the disconfirming process, and risks the confirming of a pathogenic belief, it is expected that the patient will experience an increased sense of danger and become more resistant and less insightful (Bush, Gassner, 1988, Gassner, 1990). If the therapist responds to the traumatic behaviour repeating the pattern that the patient adopted with their parent, the patient cannot be really helped in moving forward and in experiencing new ways of dealing with the trauma (Foreman, 1996). If the patient is very motivated in feeling better, and he or she normally is in a therapeutic process, he or she will eventually test the therapist again (Fretter et al., 1994).

A study conducted in 1993 by Silberschatz and Curtis on the cases of Diane and Gary, based on tape-recorded and transcribed therapy sessions, reported results indicating that the patient became more productive, relaxed and expressed more positive emotions when the therapist helped disconfirm their pathogenic beliefs by passing a test (Silberschatz, 2005).

According to Weiss, on this topic, therapeutic progress may occur even when the therapist fails tests or inaccurately analyses a patient’s pathogenic beliefs. A therapist may be using a different theoretical model and pass the patient’s most critical tests too. The idea behind this is that patients will try to get the maximum benefit from the treatment, so even when the therapist is not working efficiently, the patient might set back in their progress, but this might be only temporary. In such a case the patient will adapt his or her testing to the therapist’s style and theory. The benefit our patients receive from therapy can happen not only when we are pass tests, but also through understanding and experiencing the patient’s behavior, pathogenic beliefs, transferences and resistances (Bush, 1989). 

How can you tell when you have passed a test?

CMT is based on the idea that when a test is passed, the therapist will know it because:

1. Classically the therapist know that they have passed a test when the client begins to feel more relaxed, shares new material or switches away from the intensity of what has been going on.
2. Transference tests work more like the above
3. Passive into active tests can work like that but can also become something else. A person who has been traumatized, does not trust might just as easily be relieved that the therapist passed the test, but might also have to increase the intensity of the test and so they escalate the intensity of the Passive into Active test and make the therapist feel worse not better.

Jumping back and forth between P-A and Trans happens often.  The more damaged the individual the more there will be testing in both directions at the same time.  This can be either sequentially or simultaneously.  This process can get confusing for the therapist because it can be difficult to understand which test to address. This is where understanding the plan be helpful. The plan will support that the patient is actually working on the issues brought up by one of the parts of the testing versus the other and will help the therapist know that the knowledge held in the other part of the testing needs to be held for a while.

Failing and Passing a test.

After a minor failure – sometimes the patient will just give the therapist another chance at the same test. Or sometimes the patient will coach the therapist about how to do it the next time. Sometimes the patient will ignore the therapist. And just talk for them.

Sometimes a patient will go back to an earlier test to make sure that the therapist is on his side.  This way they go back to an earlier pathogenic believe and might not harm herself by the thought that the therapist is not on their side.

With a healthier patient, who has more trust, the failure of a test can easily be overcome. With a more damaged person – it is often more difficult.  At those times the patient does something harmful because they are complying to a pathogenic belief that is destructive.

The therapist’s role is an active one that is based on their understanding of the individual and the way in which the testing process occurs. Change in this theory happens because of the discussion /interpretations /interactions as well as the behavior and non-verbal processes that occur.  All aspects of what the therapist brings into the office are a part of the process or dance of psychotherapy.

Failing a test

Talk with your patient about it. Try to understand and correct it. Look for some coaching. Use the plan to explore what happened.