Once I have begun to create a container, a safe play space, for the dance, I need to INFER my PATIENT’S PLAN.

During my contact with my patient I am, of course, trying to understand my patient. In CMT terms I will formulate their pbs, their goals, and strategies to overcome their past traumas.  I will continually check these initial hypotheses against all new observations to confirm, alter, or dismiss them.  These preliminary theories help prepare me for their tests.  I will develop provisional formulations using: the patient’s own formulation, childhood traumas, my affective responses, and my patient’s reactions to my approach, attitude, and interventions.

The plan should help me understand all, or most of what I know or understand about my patient.  The pts goals will be based on everyday normal expectations.  There are both Stated and Unconscious goals: true goals are normal and reasonable vs. compliance’s with pathogenic beliefs.

For ex. : the pt is unlikely to really want to stay with a mean, critical spouse. They may unconsciously feel, however, that they should suffer as the parent suffered.

Patients are often in conflict, due to a wish to reveal their plan balanced against a fear that in doing so they risk re-traumatization.

How bound your pt is to a pathogenic belief may determine how clear they are in presenting their goals. Tests may reveal specific goals.  Patients are motivated to orient you and may do so vis a vis testing. They may give you mixed information to see what you pick up on.  They may hide their problems in bits of information. They may express the opposite of what they want but give you a clue, such as a weak argument.  They may display fears of rejection by acting rejecting, such as “therapist shopping.”  They may act too crazy or difficult to treat.  One needs to evaluate their traumas to sort it out!