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Beginnings
Beginnings
The Art and Science of
Planning Psychotherapy

Second Edition

Mary Jo Peebles

New York London

“Children Will Listen” and “Ever After” from INTO THE WOODS, Words and Music by Stephen
Sondheim, © 1988 RILTING MUSIC, INC., All Rights Administered by WB MUSIC CORP., All
Rights Reserved Used by Permission, Reprinted by permission of Hal Leonard Corporation.

Excerpts from A Fatal Grace used by permission of the author, Louise Penny.

Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
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New York, NY 10017 Hove, East Sussex BN3 2FA
© 2012 by Taylor & Francis Group, LLC
Routledge is an imprint of Taylor & Francis Group, an Informa business

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Library of Congress Cataloging-in-Publication Data

Kleiger, Mary Jo Peebles.

Beginnings : the art and science of planning psychotherapy / Mary Jo Peebles.
-- 2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-415-88308-5 (hardcover : alk. paper) -- ISBN 978-0-415-88309-2
(pbk. : alk. paper) -- ISBN 978-0-203-84615-5 (e-book : alk. paper)
1. Psychotherapy--Case formulation. 2. Psychiatry--Case
formulation. 3. Psychotherapy--Differential therapeutics. 4. Mental
illness--Treatment--Planning. I. Title. II. Title: Art and science of planning
psychotherapy.

RC480.5.K538 2012
616.89’14--dc23 2011040897

Visit the Taylor & Francis Web site at

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To my teachers and patients,
with gratitude
Contents

Preface to the second edition ix

Acknowledgments xiii
About the author xv

1 Beginnings 1

2 Understanding and diagnosis 11

3 Mapping 29

4 Alliance 43

5 Focus 57

6 History taking: How much is enough? 67

7 Engaging ourselves and the patient in the process 81

8 What material is important? 97

9 How can we be sure? 111

10 Trial interventions and feedback 123

11 Four models of underlying developmental disruption 137

12 What has gone right? Strengths and resilience 147

13 The structural weakness model 157

vii
viii Contents

14 The trauma model 169

15 The maladaptive character pattern model 199

16 The conflicts and splits model 207

17 Helping the patient form an alliance: Mapping paths

of trust and repair 221

18 Reality testing and reasoning 235

19 The maturation of emotional balance 255

20 The maturation of relatedness 271

21 The maturation of moral sense 293

22 Respecting the psychological costs of change 311

23 The patient’s learning style 323

24 The power of expectations: Their influence on focus,

modality, and style 335

25 Modalities 345

26 Priorities and treatment episodes 351

27 Am I the right person? 365

References 377
Index 429
Preface to the second edition

It has been 10 years since the fi rst edition of Beginnings was published.
During this time period, I have been in private practice full-time in
Bethesda, Maryland. The people whose lives I have been let into, and the
challenges in my own life, have continued the shaping of my thoughts. I
have grown more sober and respectful about the courage and diligence it
takes to truly change. I have grown clearer about the indelibility of fi nger-
prints left from early relational experiences and traumas. At the same time,
I have witnessed how, with trust and dedication within both therapist and
patient, new possibilities exist and are within grasp, at any age.
Psychotherapy is not “one size fits all.” It continues to be clear to me that
modalities and techniques are tools, to be selected from our toolbox intel-
ligently. We do not approach the selection of a wrench with narrowness
of vision, but instead observe our fastener’s size, shape, and grip strength
carefully so that we might select the wrench best suited to loosen the fas-
tener easily without damage. The more knowledgeable we are about the
usefulness of various wrenches, the more flexibly we can tackle a variety of
fasteners. Similarly, as scholars and healers, we do not approach the places
of stuckness in our patient’s growth with narrowness of vision. We partner
with her in learning who she is and what has been hurting. Together, we
fashion an understanding of why her hurt arose and why it has continued.
The more knowledgeable we are about the wisdom accumulated in each of
the core theoretical schools the more flexibly we can shape therapy recom-
mendations that attune to our patient’s developmental needs and learning
style. It is in this way that we help our patients move all the way through,
and emerge on the other side of, the dilemmas for which they seek our help.
In this book, I hope to offer you a style of engaging with the person
sitting across from you—a way of listening and entering into the space
yourself—that will help you learn this person’s world by experiencing him
and experiencing yourself as the two of you connect with each other. I also
hope to offer you a style of thinking—a way of discerning where the work
needs to begin, what tools might be useful, and why. Both processes are
essential to beginnings: authentic connection and disciplined formulation.

ix
x Preface

I put forth that you cannot fashion an adequate formulation about your
patient without entering into relationship with him.
I also put forth that change is generated only inside relationship. We
are shaped (often without intention or awareness) by the people we move
among and between, by the looks that we absorb and the ones that we
give, by the voice tones that stimulate vibrations deep inside us and by our
behaving that emerges in response, by the tasks we choose to undertake
and by the emotional energy of our cities, geographies, and altars at which
we worship. It is inside relationship that our spirit is grown and our soul is
developed.
The work of psychotherapy is about intentional change. For psycho-
therapy to reach deeply reconstructive levels, relationship must be present.
The therapeutic encounter may be only one hour, or it may span an entire
decade. In either case, a meaningful encounter, a feeling-full connection,
is what creates the deepest change—for therapist and patient alike. Thus
relationship is essential—for knowing, for formulation, for change.
To enter into relationship is to enter into an unknown. This book offers
ideas, along with concrete examples and steps, for how we can allow that
unknown to be present in beginning and how we can stay with and engage
with our patient within that unknown in ways that let light shine on her
suffering. This book gives ideas and transcripts for how we can recognize
the information that is emerging in front of us, can organize that informa-
tion to direct us to what needs to be understood next, and can then partner
with our patient to cocreate a plan for treatment from the “next” that unfolds.
I strove to be pragmatic as I wrote this book. This is because I was in
relationship with you, the reader, and I was in relationship with myself as
one who has also read to try to learn. I wanted us both to come away from
this reading experience with something concrete in our hands—things we
could do, try, play with; pictures of what beginnings actually look like.
Learning to do psychotherapy is difficult. Learning to be in relationship
in psychotherapy—therapeutically—is even more challenging. Please under-
stand that it takes much more than a book, or words, or specific guidelines,
to put all these things into play. Louise Penny (2006), a Canadian author,
put it this way when she described how her character, Chief Inspector
Armand Gamache, was capable of persisting and understanding the deeper
parts of people:

Beauvoir suddenly remembered the lesson he always hurried to forget.

Gamache was the best of them, the smartest and bravest and strongest
because he was willing to go into his own head alone, and open all the
doors there, and enter all the dark rooms. And make friends with what
he found there. And he went into the dark, hidden rooms in the minds
of others. … And he faced down whatever monsters came at him. He
went to places Beauvoir had never even dreamed existed. (p. 74)
 Preface xi

Find a psychotherapist or a supervisor from whom to learn. With their

help, discover the deeper, even the darker, parts of yourself. Learn with
humility and compassion how to be your fullest self, with trust and safety,
so that you can be in relationship with those whom you meet in the consult-
ing rooms of your career. Select your teachers and mentors wisely. Choose
those people who live out (not just speak about) the traits that bring mean-
ing to you. We become like the people with whom we surround ourselves.
I am grateful for this chance to enter into dialogue with you, the cli-
nicians and students who will be opening this book and reading it for
the fi rst time, as well as with those of you who are revisiting these ideas
through the update of this second edition. I welcome your thoughts and
your puzzlements—your ideas about where the ideas in this book fit with
the work you are doing and where you feel they do not. We are healthiest
when we entwine our lives in community. No one can do this work alone.
I am fortunate to begin, through your reading of this book, to become a
part of your community.
Acknowledgments

Much of the spirit and content of this book was gleaned from lessons
learned at the Menninger Clinic, in Topeka, Kansas. I was formed, as a per-
son and as a professional, by my 22 years there, and I am grateful to have
had a taste of the richness of that community. Participating as a team mem-
ber on long-term inpatient milieu treatment units and in intensive, week-
long outpatient evaluations committed me to the value of interdisciplinary
partnership and was irreplaceable training in going beyond the illusion of
understanding offered by a diagnostic name to discover the essence of suf-
fering and possibility within a person’s fears, hopes, failures, and strengths.
In that era, Menninger was a place that reserved the best parking spaces for
patients; put money into good people before spending it on new buildings;
had the daring to build a copper-walled room in which master medita-
tors could be studied; trained people in horticulture therapy, psychodrama,
and biofeedback alongside American Psychoanalytic Association–affiliated
psychoanalysis; and developed and funded the best freestanding psychiat-
ric library and staff in the country. Controversies abounded, and from the
intellectual fervor patients benefited and grew. The willingness to not know
and to learn together, the uncompromisability of humane respect, the valu-
ing of creativity, and the essentialness of offering hope1—these were the
relational qualities with which one was treated and which, in turn, infused
how one treated others.
In the acknowledgments for the fi rst edition of Beginnings, I named
invaluable mentors, students, and friends to whom I continue to feel emo-
tionally and intellectually indebted. I want to add here my gratefulness
for the unexpected travels in my life that led to serendipities—fortunate
discoveries of things that I had not been in quest of. In Galveston, Texas,
I learned family systems therapy and theory and absorbed how people’s
symptoms and feelings often were speaking the not-yet-speakable, but
needing-to-be-spoken, within a family or group. In Rockville, Maryland,

1 “You have given them hope, something money can’t buy and possibly the most basic human
psychological need” (F. Shectman, personal communication, February 2011).

xiii
xiv Acknowledgments

I was graced with learning from remarkably open clinicians at Chestnut

Lodge Hospital who were dedicated to understanding the sanity and truth
embedded in their patients’ psychoses—truths too often painfully refused a
hearing by those unfamiliar with the clarity inside a patient’s mix of com-
plexity and bluntness.
Collaborations with colleagues and friends during my recent private prac-
tice years have deepened my realizations that a thought is never fully birthed
until it is allowed free dance in the space of conversation between two
people, and that the most creative ideas are always cocreated in the sponta-
neous interchange between people who trust each other. Rick Waugaman,
Elisabeth Waugaman, Bryant Welch, Ron VandeLoo, Fred Shectman, Ann
Louise-Silver, Len Horwitz, Veena Kapur, Tony Bram, Rachel Ritvo, Inger
Peebles, and Paul Peebles are but a few of the people I cherish and am
grateful to for helping me continue to grow as a person and clinician. My
colleagues and friends at the American Society for Clinical Hypnosis and
the Society for Clinical and Experimental Hypnosis have taught me for 30
years. I must mention again my thanks to Rick Waugaman, whose generos-
ity touched me when he insisted on proofreading the entire fi nal copy of
Beginnings’s fi rst edition, and my current thanks to Bryant Welch, who
unstintingly offered elegant line edits of several chapters of this second
edition.
The fi rst edition of Beginnings would not have taken shape had it not
been for the intellect and editorial acumen of John Kerr, editor at the
Analytic Press. He helped knead the raw material of book drafts into the
fi nished product of publishable chapters. The second edition of Beginnings
was thought into existence by Kristopher Spring, associate editor with
Routledge. Kristopher conceived the idea of a second edition and encour-
aged and assisted its development with his perfect mix of easygoing confi-
dence, constant fresh enthusiasm, and push. Copyeditors and design staff
at both publishing companies were silent coauthors.
Finally, my understandings are possible and made real only by my
patients who entrusted me with their hidden sides and their honesty. And I
owe an incalculable measure of my growth and joy as an adult to my chil-
dren, who let me in, spoke truth to power, followed their dreams, and loved
me through my foibles. Thank you.
About the author

A graduate of the Topeka Institute of Psychoanalysis, Dr. Mary Jo Peebles

received her undergraduate degree in Psychology from Wellesley College
and her PhD from Case Western Reserve University. She is Board Certified
in Clinical Psychology and in Clinical Hypnosis and was formerly an asso-
ciate professor in the Karl Menninger School of Psychiatry and a member
of the Medical Staff of Chestnut Lodge Hospital. Currently Dr. Peebles
works in private practice in Bethesda, Maryland, with children, adoles-
cents, and adults.

xv
Chapter 1

Beginnings

I am always a little nervous when I meet a patient for the fi rst time… . If
I’m not, I know I’m not fully present.
Richard Maxfield, from a class lecture in the Menninger
Postdoctoral Fellowship Program in Psychology (1980)

You open this book, and you are hopeful. Or perhaps skeptical. Or … how
many dozens of other possibilities? Take a moment. Notice what you are
expecting, seeking, wanting. Notice that you have anticipations. You are
beginning with me, and before we have even “met” at any length through
the pages of this book, you are already holding hopes, needs, protections
against disappointment, and anticipations of what “working with me”
might be like, might offer or bring. As you open into listening to yourself
inside this internal space, you can begin to appreciate how much is actually
held inside beginnings.
Beginnings hold a fullness of unripened possibilities—seeds planted long
before two people meet, within the soils of their respective histories, car-
ried by them to each new encounter. The fi rst step in planning psychother-
apy is to open up space for the beginning to be listened to. It holds valuable
information about what the patient is seeking, what she1 is expecting to
fi nd, what has gotten in the way of her being helped in the past, and how
things might go differently in the present—in short, things important to us
when planning psychotherapy.
The people we meet in our consulting rooms have tried many things
already to help themselves. To expand their chances of reaching what they’ve
been seeking, we want to open up space, for everything to be present—the
hidden as well as the visible. Only then can we begin to begin, can we catch
glimmers of missing, can new combinations emerge, and can possibility
germinate, have room to breathe, and grow. We open up this space by slow-
ing experience down, by listening, and by allowing the unknown.
1 So that both men and women can experience places of seamless familiarity as they read this
book, I will alternate, by chapter, the gender of unreferenced pronouns.

1
2 Beginnings

SLOWING EXPERIENCE DOWN

Wisdom begins in silence.

Robert Lawrence Smith
A Quaker Book of Wisdom
In our speeded up age of text, Twitter, continuously scrolling CNN news
tickers, fl ipper graphics refreshed every five seconds, pop-ups, and multi-
screen feeds simultaneously viewed, we are losing the ability to slow down
communication to an emotionally manageable level. People continue con-
versations with each other while simultaneously texting, iChatting, and
scrolling through Facebook posts. We boast of being adept at multitasking.
What we fail to grasp is that the mind’s capacity to hold the hundreds of
resonances tripped by those tasks, and its ability to track and grasp the
multiple swirls of feelings correspondingly stirred, lag light-years behind
the speed of simply registering flat data bits. We can crunch incoming
words and numbers faster than we can comprehend what we are feeling
in response to what we just crunched. The emotional self gets left behind
in the dust. We’re flooded. Only we don’t name it that—instead, we act
irritable, feel edgy, and caffeinate ourselves to push through the inevitable
fuzzy space that envelops.
Playwrights know the fullness that lies under words and inside spaces.
Actors learn the depth of a pause, the magnitude of a silence for car-
rying huge weights of information. Particular words strike resonating
chords—stirring cultural connotations or personal ones. The tone and
inflection of the speaker tip and amplify meaning. The resulting cascade
of emotions and thought balloons are too large to squeeze through the
narrow neck of fast-paced banter. We may be agile at processing the
top layer of text, but it’s the multiple currents flowing beneath that clog
everything.
Our job as therapists is to open space adequate for hearing, appreciating,
and soaking in all that is being said and taking place. We do this by slow-
ing things down.
Slowing things down doesn’t mean holding up a stop sign. A slower
pace is reached by quelling our impulse to jump in, to react, to too quickly
assent, banter, or offer solutions. It values pausing, using the space to hear
the resonances and remark on them. It appreciates when the patient has
just put a huge quantity or particularly weighty piece out on the table and
enjoins her to share that moment of appreciation with us. It takes seriously
what is getting tossed off glibly, not by being heavy handed but by being
thoughtful and reflective.
Slowing things down paradoxically expands time. It expresses
interest—in what’s around the edges, what’s lying underneath, what’s held
just inside the parcel of information the patient just offered us. Because
 Beginnings 3

we are interested and attentive (not pressing, suspicious, or vigilant), most

patients feel us hearing and respond by saying more. We encourage them
to hear with us what they just said. We model a surety that what is taking
place is important. In these ways, we create the space for both of us to
begin to listen, in a different kind of way than life outside the consulting
room usually affords.

LISTENING

“Agent Lemieux, our job is to fi nd the sense.”

“How?”
“We collect evidence, of course. That’s a big part of it.”
“But there’s more, isn’t there?” Lemieux knew that Gamache had a
near perfect record. Somehow, while others were left baffled, he man-
aged to figure out… . Now Lemieux stood very still himself. The big man
was about to tell him how he did it.
“We listen.”
“That’s it?”
“We listen really hard. Does that help?” Gamache grinned. “We lis-
ten ’til it hurts. No, Agent, the truth is, we just listen.”
Louise Penny
A Fatal Grace (2006, p. 90)
How many times do we hear what is being said? How many of those times
are we listening as we hear?

Being open
Listening is more than registering and recalling auditory information. It is
a taking-in of everything that is there. It means opening, without arbitrary
barriers, to being entered and to the content that enters.
To be open in this way, one needs clear boundaries. These boundaries
arise from a steady sense of oneself and a steady way of tracking what is
taking place inside—how one is feeling and responding in the moment,
what is being stirred, where those stirrings come from. Healthy boundar-
ies also are molded from a clarity about what is unsafe, and why, for our
patient and for us—a clarity that comes from comprehension not just of
factual knowledge but of one’s professional code of ethics. Boundaries
provide the buoyancy that allows us to hold on, to ride the unexpected
wave intact, to come back readily to the surface when we have momen-
tarily been washed under. We may experience fear as we take the other
in, but we can ride that fear as simply a wave that can wash over and pass
through us. We may feel ambushed, but we know how to stabilize, how
to let the uncentering occur and then how to return to center, in order
4 Beginnings

to better see. Such abilities are not acquired lightly; one works at their
development in one’s personal therapy, in supervision, and throughout
one’s life.
We are all human; thus, we can understand the human experience of
anxiety in the face of feared emergency. We can appreciate how some-
times each of us reactively erects emergency boundaries that are actu-
ally barriers, usually brittle and unhelpful (to us or to our patient). For
example, we may fi nd ourselves inadvertently trying to push comments
back into our patient by prematurely taking issue with their accuracy or
by misguidedly feeling called upon to justify or explain our “position”
(e.g., Epstein, 1979). This usually occurs when the accuracy or emotion
or penetration of what our patient is saying is unexpected or difficult
to process, making it hard for us to tolerate and hold inside for a few
minutes until meaning and context emerge more clearly. We may begin
to speed up—talking faster, or too much, or bringing in too many ideas
in one sound burst—when something has just made us anxious. We may
catch ourselves diverting the conversation to a peripheral detail, because
something inside the place central to where the patient is was somehow
difficult for us to stay with. Or we may rue an abrupt shift in our tone
toward edginess, critique, or tension; then realize we are trying to break
something threatening into imaginarily conquerable bits. There are as
many variations of these emergency boundaries as there are people. With
attentiveness, over time, we learn to recognize our particular style of
erecting them and to use their unexpected appearance as signals to our-
selves that we must be momentarily disrupted or overwhelmed. Through
doing so, with compassion toward our own vulnerabilities and toward
the time it takes to learn, we can develop the ability to right ourselves and
return to listening.

Being porous: Growing the ability

to listen to ourselves
When we open, we are allowing ourselves to be porous. It is reassur-
ing to understand that being porous does not mean losing defi nition or
becoming diffuse. Nor does it mean passivity or allowing unrestricted
vulnerability to unsafe exposure. We allow porousness; we admit pas-
sage of the outside in. These are judicious acts; by using awareness, we
render them active choices. And, by so doing, we retain self-defi nition
and clarity of presence, even while we are allowing things from the out-
side to come in.
An interesting phenomenon, and often-neglected realization, is that
the porousness of openness occurs in more than one direction. Not only
are we opening ourselves to experiencing what is in our patient, but in
so doing, we also are opening ourselves to experiencing what is inside us.
 Beginnings 5

And what is inside us is also opened to being experienced by our patient.

Awkwardly, what becomes visible to our patient along this other side of the
two-way street is not always anticipated by us, nor does it always occur by
our choice. Our patients see into us, much as we feel ourselves seeing into
them. Our patients may not understand what they are seeing, much less
know what to do with it, and many will not know how to articulate it, but
they will react to what they pick up.
In addition, we will react to experiencing the inside of our patients, and
more: We will react to experiencing the inside of ourselves—those per-
sonal feelings and memories held inside our interior spaces that (sometimes
unexpectedly) get blown open, or simply stirred, by something our patient
is saying.
We can’t avoid this way of communicating, if we are open. But we can
keep things buoyant and resilient, effectively helping our patient, if we
learn to know ourselves. It is important for each of us to understand,
more or less, what has lain inside us, why we came to this work, what
our suffering is, where lie the wounds—their size and shape, and how
we have tried to heal (or hide) them. The fewer unknown spaces, the
less fear. The less fear, the more we can allow the porousness necessary
for listening.
Don’t get me wrong: There is always the unknown, always the unex-
pected. But the more we have navigated our own dark places, the easier it
becomes to travel with our patients into theirs. And, the easier we fi nd it to
respond with less disruption and more humanity (and thus more helpful-
ness) when our patient unwittingly but accurately perceives something in us
we hadn’t known was visible.

ALLOWING THE UNKNOWN

Into the woods,

Where nothing’s clear,
Where witches, ghosts
And wolves appear.
Into the woods
And through the fear,
You have to take the journey …
Into the woods—you have to grope,
But that’s the way you learn to cope.
Into the woods to fi nd there’s hope
Of getting through the journey.
Stephen Sondheim
Into the Woods (1987)
6 Beginnings

As Stephen Sondheim discerned within the fairy-tale narratives of centuries

ago, our lives are journeys, usually quests—and sooner or later, our quests
take us “into the woods.”
When our patient arrives at our door, she usually does so because she
has landed in her woods, in one way or the other, and she is anxious to fi nd
a way out—quickly! She wants us to tell her which way to turn: Where is
the path? Can she hope for the light to reappear? Is she hopelessly lost? She
may be afraid to ask these things directly, but she is feeling them. To help
her fi nd her way, to piece together where she is and what her way might be,
we must enter her woods with her, move through the dark alongside her
without making her darkness our own, and bring our eyes, ears, experi-
ence, and knowledge to bear on the task of deciphering where she is, where
it might help her to be instead, and what the clearest way of getting there
would be. To do these things, we not only must slow things down and listen
carefully but also we must be able to tolerate the dark. We must know how
to allow the unknown.

First tolerate …
It is scary to enter the unknown, “Where nothing’s clear / Where witches,
ghosts / And wolves appear” (Sondheim, 1987). We will be afraid. We will
be afraid of the darkness of nothing being clear. We can’t know immedi-
ately what is wrong with our patient; we can’t know if we will be able to
help her. We can’t know exactly what she is saying or meaning. We will feel
moments of confusion, if we are honest.
We also will be afraid of the monsters—the witches, ghosts, and
wolves—that might be lurking around the corner. The primitive in peo-
ple, the unexpected, the chaotic, the out of control: It is no accident that
these things—and the suspense of wondering if and when they might
strike—are the stuff of horror movies and terrifying thrillers. They are
used in such movies because they reliably make us feel fear. When we
let ourselves enter the woods of our patient with her, when we allow the
unknown to unfold, we open space into which primitive, unexpected,
and chaotic things might stir. We thus expose ourselves to the possibility
of fear.
Our minds, reflexively, will try to not let us do this. Whatever stimulates
fear is registered in our limbic brain as unsafe; therefore, from early on, we
track the characteristics of encounters and people and amass a mental fi le
drawer full of patterns. When encountering the new or unknown, we are
programmed to speed-flip through these archived patterns, dimming any
differential nuances or ambiguities as “noise” or artifact and thus clearing
the way to leap, “successfully,” to rapid conclusions about what is in front
of us, what is taking place, and how it will likely turn out. This kind of
advance “certainty,” in the form of such reflexive conclusions, is how our
 Beginnings 7

brain strives to keep us safe. It is presumed so essential that we typically

don’t realize the process is taking place. Blink! (Gladwell, 2005).
The problem with reflexive conclusions derived from the pattern-recognition
of expectations, however, is that the data upon which the conclusions are
based are compilations of past experiences. In short, we are concluding that
what will happen is what has happened. In this mode of processing, there
lies little room for new possibilities or new discoveries, since the objective
is to limit the unknown. Therefore, in order to create space for fresh ways
of appreciating the tangle of the patient’s woods, we must mindfully decline
the unseen spin toward rapid conclusion and allow the uncertainty of the
unknown to rest, untampered with, just for a bit.
We also must resist the seduction of judgments (ours or our patient’s).
These might be blatant, such as the patient’s openly berating herself for
being “crazy,” “weird,” “selfish,” “mean,” “overly dependent,” “too
complaining”—the list in most of us unfortunately goes on. Or judgments
can be sophisticated and implicit, such as the therapist’s fi nding himself
thinking in diagnostic shorthand like “borderline … bipolar … narcissistic
… OCD” early, inside the listening space. There is a place for the structure
of diagnostic landmarks, to help orient aspects of the treatment. However,
inside the initial listening, if no safety issues are present, their emergence
often signals anxiety about letting the experience of the patient, inside her
woods, just be there, in all its unknown.
Thinking in labels, when we are beginning, usually means we are try-
ing to bag the primitive, chaotic, and unexpected before it has a chance
to jump out and catch us unawares. Just as refl exive conclusions manage
uncertainty by weaving false certainty, so, too, judgments manage the
monsters by spinning false mastery. Both stifl e exploration and warn
away what has lain hidden in the patient. To have a chance for some-
thing new to be understood, we want “everyone” to be present—the
cast-out and hidden along with the acceptable; the previously peripheral
having equal say with the accustomed central. It is only through breath-
ing space into what comes to us already constricted, concluded, judged,
and “known” that we can hope to discover the fresh ideas and the new
solutions.

Then, embrace …
“You have to grope / But that’s the way you learn to cope / Into the woods
to fi nd there’s hope” (Sondheim, 1987). In short, the more unknown, the
more possibility.
If everything’s already been thought of, and already tried, then what
can we offer our patient that is new? Don’t we hope for there to exist some
unknown in what she has struggled with, in what she has considered, so
that there is a chance for tweaking the parts into a new configuration,
8 Beginnings

for seeing things with that half-a-degree difference, that half a degree that
makes a difference?
If we are unafraid of the unknown, and embrace it as opportunity, our
patient will learn to be unafraid, too. Therefore, we give ourselves permis-
sion to not know. We momentarily lay aside our familiar strivings to know
and instead embrace the space of not knowing as fertile ground for discov-
ering and creating. We see the unclear and tangled spaces in the patient and
in her story as opportunity for learning, as freedom to play with ideas. We
understand that the more unclarity there is—the more that is undefi ned
and not predetermined, the more “loose parts” in an environment (Louv,
2005)—the greater will be the chances for inventiveness and creativity.
Being able to not know doesn’t mean never knowing. It doesn’t mean
relinquishing the interest in knowing or discarding one’s confidence that
knowing and learning will take place. Nor does it mean insisting on stay-
ing unknowing if doing so leaves us unsafe. Being able to not know means
not having to pretend understanding when it’s not yet there; it means not
having to force connections before they fit; it means enjoying a relief from
feeling insecure if one doesn’t have “the answer.” Often, the art of crafting
previously unasked questions and generating methods of inquiry opens up
vaster expanses of landscape to see into than scrambling for answers does.
And answers are more complete if nourished by curiosity and unpressured
exploration.
Thus, Sondheim’s musical Into the Woods was a little about fairy tales,
a little about life, a little about psychotherapy—and a lot about the vicis-
situdes of the human pilgrimage that all three have in common. Allowing
the unknown of the woods stretches and strains what we thought we could
bear. But, in so doing, it strengthens our confidence and expands opportu-
nities for new experiences, which can blossom into alternatives for the old
solutions. You learn to grope; you fi nd there’s hope. If we don’t encoun-
ter something unexpected from our patient in the fi rst hour, we have not
allowed enough unknown.

BEGINNING TO MAP

More than likely, you opened this book to fi nd answers to what to say to
your patient in the fi rst few hours of conversation, to know what to look for
and how to look for it, and to seek guidelines for choosing among the jum-
ble of techniques and modalities. You were invested in developing a plan for
your patient’s psychotherapy rather than simply proceeding, because even
heartfelt intentions cannot muffle an occasional, uncomfortable sense of
vagueness or doubt about a treatment’s path.
We will address, in subsequent chapters, just such questions and look at
suggested ways to think about them. We will consider a way of “mapping”
 Beginnings 9

our patient’s woods, with caution tape for the hidden holes, signposts for the
stockpiles of resources, examination of lessons learned from prior efforts,
and careful consideration of the layered tangles that may have impeded the
way out previously. The goal is developing a textured (but still pragmatic)
perspective (plan) of how to get from here to there.
But fi rst it was important to pause, in this initial chapter, to appreciate
how much takes place and is held inside beginning itself. It is important to
consider a manner of approach—slowing things down, listening, allow-
ing the unknown—that opens the space necessary for what is meaningful,
both inside the patient and between us and our patient, to emerge. We
don’t want to lose opportunity in a rush for classifications that only pose as
answers. As Saint-Exupéry wrote in The Little Prince, “What is essential
is invisible to the eye.”
I understand that to take the ideas in this fi rst chapter seriously chal-
lenges us. It does so because to slow things down opens us to ourselves.
It puts aside the noise generated by clambering for diagnoses and inserts
silence in its place. But this is not an empty silence; rather, it is a silence
filled with listening, to what is not being said, to all that is being spoken
that can’t usually be heard. Still, this kind of silence can feel threatening,
because it is inside this kind of silence that what is inside us emerges, too.
Thus, taking the approach in this fi rst chapter will expose us to our-
selves, to our own woods, our own monsters. Following the suggestions
offered in later chapters for how to elicit information useful to mapping a
path will require us to enter into relationship with our patient ourselves, to
be fully present and engaged, to allow our engagement to be a part of the
learning about what has impeded this person’s ability to move through her
suffering. This is a form of intimacy, and intimacy isn’t easy. We will need
to know how to map our own terrain (Peebles, 2010).
I am hoping, in this second edition, to bring more explicit emphases to the
unstoppable processes of growth, to the importance of building on our patient’s
existing and underdeveloped strengths, and to the centrality of a developmen-
tal model—a model in which our role as therapists is first to discover what has
interfered with natural growth and development and second to repair, rebuild,
restructure, or clear away as little or as much is necessary to return our patient
to her unique developmental path. I want to convey a respect for illness, while
offering the perspective that suffering is our focus, that suffering is universal,
that we are all “patients” (from the Latin patior, “to suffer”) at one point or
another, and that there is more alike about us than different.
We search for the recognizable in our patient; we search for what will
allow her to feel fully human rather than alien. As Carlton Cornett (2008)
put it when elaborating on one of Harry Stack Sullivan’s concepts, “The
more willing a clinician is to acknowledge the aspects of her or his own
development that are similar to those of the patient, the more likely she or
he will be able truly to hear the patient” (p. 263, emphasis in original).
10 Beginnings

This second edition also emphasizes that symptoms are simply solu-
tions that have become problems. Pain is inevitable in the human journey.
Suffering occurs when human pain cannot be fully moved through and we
sit stuck, inside the pain. Symptoms then arise, as attempts to address the
pain or stem the suffering. As such, symptoms hold important information
and wisdom. The approach in this book is to listen carefully and respect-
fully to the wisdom held inside our patient’s symptoms in order to hear more
clearly what kind of stuckness has been generating her suffering—what
dilemma her symptoms have been trying to solve—so that we might plan
a psychotherapy that understands the origins when trying to address the
manifestations. With our patient, we develop a map of what she’s been try-
ing to solve in order to generate alternative solutions that ideally serve her
better.
Finally, this second edition expands the discussion of multiplicity begun
in the fi rst edition. Multiplicity is the notion that there can exist a simulta-
neity of truths—equally valid, potentially enriching each other if we give
them equal voice (instead of pitting them against each other in an either-or
battle). In the fi rst edition, we looked at how this is true in mental health
for theoretical perspectives and therapeutic modalities. We will consider in
this second edition how it is also true for mental functioning: how normal
development contains a multiplicity of self-experiences, layered and inter-
woven over time, and how heightening awareness of the different voices
within one expands the fullness of experience, enhances empathy, and
enriches solutions.
Now that we have opened space to allow for uncertainties, let us consider
the conundrum of how to make diagnosis therapeutically useful.
Chapter 2

Understanding and diagnosis

If therapy is to end properly, it must begin properly. … The act of therapy

begins with the way the problem is examined.
Jay Haley (1976, p. 9)

What we choose to examine with our patient (and how we do so) in the
fi rst hour is itself an act of therapy. It communicates implicitly our theo-
ries about what change is, how we experience our patient, how he will be
involved in the process of change, and who we will be for him during that
process. As Frank and Frank (1991) have pointed out, most healing aspects
of therapy lie outside mechanics and specific techniques. Who we are and
the competence, hope, and humanity we convey register as strongly, if not
more strongly, than the particular modality we eventually select.
Many of us are taught to think fi rst of diagnosis when we examine
patients. We assume this is the place to begin, and we may assume each of
us is thinking similarly in terms of what diagnosis, and its role in begin-
ning, is. The truth is that diagnosing is not the only way to “examine the
problem.” Furthermore, even if we choose to diagnose, there are many
different things one can diagnose. And some things we traditionally have
chosen to diagnose actually offer little direction for where to begin psycho-
therapy. Let’s take some time in this chapter to explore diagnosis and to
paint perspective into its role in planning psychotherapy.

DIAGNOSIS AND UNDERSTANDING:

COMPLEMENTARY WAYS TO
EXAMINE THE PROBLEM

Mull over the following: Diagnosis is not understanding.

Diagnosis and understanding—each brings a different experience to sit-
ting with the patient. Each reaches different information. Both are impor-
tant. The art in beginning is to be able to move securely around, between,
and inside both modes of awareness.

11
12 Beginnings

Diagnosis is a very “left-directed” activity.1 Derived from the Greek

Gnostic, meaning “knowing,” and dia, a more textured word meaning
both “through” and “apart,” diagnosis connotes thoroughly knowing by
discerning the apartness of things. Di in one instance is said to allude to an
instrument for looking through, like a spyglass (Weiner & Simpson, 1991).
Thus, diagnosis peers at things from a distance in order to assemble them
into distinguishable categories or classifications.
On the other hand, understanding, 2 in the way we will explore the con-
cept in this book, emerges from right-directed thinking. Evolved from the
Old English standan, which means “to be present,” and under, “in the
midst of” or “close to” (Weiner & Simpson, 1991), understanding connotes
knowing by moving closely into an experience and being present there. It
is apprehension of the nature of a thing. Thus, understanding learns about
another through comprehending an experience, rather than through identi-
fying distinguishing features of a particular classification.
Being aware of this distinction benefits our patient, because recognizing
which of the two activities we are engaged in allows us to choose which
one to emphasize, when, and for what purpose. Further, as marketing
experts and politicians know (e.g., Westen, 2007), the words we use not
only reflect our thinking but also direct (and limit) where our thinking
goes. When planning therapy, we want to conceptualize our activity in
ways that allow access to as full a range of knowledge as possible, rather
than unwittingly confi ning ourselves to a word that may restrict the limits
of what we consider.
The differences between the activities of diagnosis and understanding
show up in the very fi rst moments of encounter. Imagine walking down the
hall to the waiting room to meet a new patient, Howard. Expectable glim-
mers of nervousness about whether you will be able to help, or know what
to do, flicker through your mind. When you settle your anxiety by organiz-
ing your thoughts around diagnosis, you tip your mind-set into examining,
scrutinizing, naming, remembering questions, needing answers, staying on
top of pathology, and discerning the accurate disease. You are looking for
facts (dates, length of time, particular symptoms, techniques). In contrast,
when you settle your anxiety by remembering you are simply meeting a
person, someone who is likely more nervous than you are, someone who
is suffering in some way, who is courageous enough to seek help, and who

1 Pink (2005) coined the terms left-directed thinking and right-directed thinking that will
be used throughout this chapter. See his book for a creative synthesis of the characteristics
and relative advantages of each.
2 The word understanding will be italicized throughout the book when it is referring to a
way of learning about our patient through listening to and taking in the patient experien-
tially, from the inside spaces of the patient’s worded and unworded experience, “right-brain
to right-brain” (Schore, 2009), allowing openness to (and unforced synthesis of) the flow of
sensory, limbic, and conceptual information in concert (D. Siegel, 2010b).
 Understanding and diagnosis 13

in these fi rst few moments most needs someone to care, be real, and offer
some hope of understanding, then you tip your mind-set into being, lis-
tening, attuning, wondering, learning together, and modeling compassion.
You are creating an experience. This is how choice of word shapes mind-
set, how mind-set shapes the information we seek and how we seek it, and
how both shape the way we relate to our patient in that fi rst hour.
The mind-set of diagnosis literally activates brain areas different from
those of understanding. When inside diagnosis, you can feel the gears of
accumulating discrete data points whir into motion; you can experience the
pleasure of efficiently sequencing and prioritizing facts and sense the click
of locating the patient relative to others, on a grid, graph, continuum, or
in a compartment. When in the mind-set of diagnosis, notice how keenly
you scrutinize and how the questions that occur to you are the ones whose
answers will fill in boxes preset before you met the patient. Pay attention
to how you need the patient to respond to your questions with answers
that provide the information that completes the boxes. You may notice a
sense of pressure or tension when the patient fails to do this and goes off on
tangents. If the patient’s answers don’t contain the information you need,
likely you will ask the question again. Now reflect on how this quest for
particular factual information bends your relationship with the patient into
a hierarchical one, you as active questioner and he as passive responder.
Transposed back to the session with Howard, you hear him mention
how difficult it has been to get out of bed lately. You immediately visualize
the checklist you need to traverse. It is clear-cut. You ask him about his
sleep, his appetite, and his weight changes. You proceed to difficulties with
concentration and feelings of worthlessness or hopelessness. You gently but
purposefully move into questions about self-harm and suicide. These ques-
tions are preformed. Whether Howard is Alice, or whether Howard is 25 or
65, you know to ask the same questions. You focus on presence or absence
of symptoms and on numbers—for example, number of hours of sleep,
middle-of-the-night versus early-morning awakenings, numbers of days per
week. Your analytic capacities organize these facts to triage emergency,
urgent, or nonurgent care. This is good patient care because, by adequately
covering these areas, you are protecting Howard’s safety. The diagnostic
mind-set is well suited for doing this.
But what about the mind-set of understanding? What kind of informa-
tion does it provide us, and what is the value of that information? How do
we obtain that information and organize it? And how does the focus of
understanding shape our relationship with Howard? We will spend a good
portion of this book illustrating answers to those questions, but let’s catch
a brief glimpse now.
The mind-set of understanding activates brain areas responsible for reg-
istering sensory sensations, grasping gestalt, visualizing, and experienc-
ing multiple flows of information moving around, through, and with each
14 Beginnings

other (e.g., see Siegel, 2010a, 2010b). When practicing understanding, we

experience rather than analyze. We recognize or find the patient rather
than amass information and create him (Bromberg, 2006; Molad, Vida,
Bassett, Barish, & Dubois, 2007; Pizer & Pizer, 2006). Understanding
is an “implicit right-brain to right-brain communication” (Schore, 2009,
p. 115) that literally takes the other in through one’s pores.
Through understanding, we elicit spontaneity. We welcome tangents
and stories. We don’t pretend to know answers.3 We invite the patient to
help us craft the dilemma and reflect on possible solutions instead. Why?
Because so much of what is essential in a person emerges underneath and
around what is spoken; it is exchanged inside the space between therapist
and patient (e.g., see Bromberg, 1998; Frank & Frank, 1991).
How can we open that space to our mutual consideration? How can we
allow the richness of information contained in that space to enter into the
planning of psychotherapy? Here is where the methods of understanding
come in. When we let ourselves be with the patient (“moving under and
within”), flow with and follow him (attunement), allow him to be who he is
without our judgment, and ask his permission to learn from him what his
world is like, we create an experience that allows the patient to relax into
being real and ultimately showing, rather than telling, who he is.
Let’s elaborate further. When a person feels safe, he is better able to open
to himself. The safer he feels, the more he is able to speak that openness to
his therapist. This speaking, aloud, to the other about what is inside is the
fi rst risking. It is the risk to be what one is, in the moment. If the patient
then feels heard, he will continue and speak more. The conversation that
ensues, back and forth between patient and therapist, creates understand-
ings that could not occur inside the mind of either alone. Speaking aloud
moves disembodied thought (that which tends to bounce around endlessly
inside one’s head) to the outside, into the realm of actual existence in the
sensory world. When this speaking occurs in relationship with another
who is listening, the thoughts become no longer merely sensorial, but now
felt as experienced by another.
When the therapist allows herself to fully experience what the patient is
speaking, the patient feels himself being taken in and held, in a nonattack-
ing, compassionate, interested way. This experience—of being emotionally
taken in and having the opportunity to hear one’s thoughts reflected back
accurately by a safe person—engenders more trust and more clarity about
what one feels and thinks. The patient slowly moves into risking more
knowing of himself, more tentative exploring, and more speaking. It is this

3 As R. M. Waugaman stated, “Once we decide we know, we stop questioning. Learning

about what is not known only happens if we know there is more we don’t know. Therefore,
we must keep questioning what we think we know” (personal communication, October 6,
2009).
 Understanding and diagnosis 15

delicate blossoming of articulation of the spaces underneath the words that

allows patient and therapist to see more visibly the internal and interper-
sonal bramble and knots that have tangled the patient’s growth.
We cannot get at this bramble with preset questions, because every per-
son’s story is unique, and most of us do not know how to describe the
innards of our problem at fi rst swipe. If we did, we might not be seeking
another’s help. Usually, initially, we tend to feel it and show it more than
know it and describe it. And it is the innards—the details of the bramble
and knots—that shape the core focus and preliminary outline of a patient’s
treatment plan. This is the value of the information obtained using the
mind-set of understanding.
Poetic words. But what does this look like—for example, with Howard?
When Howard mentions he has been having difficulty getting out of bed in
the mornings, you know where you need to go inside the diagnosis mode—
but wait for a moment. Is Howard going to bolt from the session? Is there
time left in the hour? Is there anything Howard has said thus far, or any
way he has acted, that suggests you need to move into diagnosis mode
immediately and with urgency? If so, then do so. However, if not, can you
follow the slight downturn of his eyes, the faint sigh, that rueful recovery
smile he just gave you that seemed to come a little too quickly? Can you
move into an understanding mind-set?
Nod, and maybe comment, “That can feel pretty miserable. What hap-
pens when you lie there?” Follow his lead, and his style, but elicit his story.
You want to be there. What is that bed like for Howard in the morning?
What does he hear, see, think about, feel? How does he fi nally rouse him-
self? Who else is there and what do they say? How does he feel about him-
self while this is happening? How does he feel about himself as he is telling
you all this? Howard will not only feel you are really interested in what life
is like for him down in the nitty-gritty of those heretofore-private moments
of his personal purgatory—he also will be allowing you a glimpse into the
content of his despondency, the means he uses to bounce back, his attitude
toward himself and his pain, the attitudes of those around him, and how he
feels about asking for and receiving help. Moreover, you have just commu-
nicated that anything can be spoken, there is hope, someone is interested,
and we can tackle what is important to him—all without saying a word,
“just” listening.
It will be important to bring understanding’s partner, diagnosis, back
into the room before the session with Howard is over. But if there has
been room for understanding, then the preset questions of diagnosis that
need answering can now be phrased in Howard’s language, closer to his
actual experience. He will feel there is a connection with him rather than
alienation. And, to paraphrase Jay Haley, something therapeutic will be
taking place. If Howard wonders aloud with you what therapy will be like,
you can answer, “Pretty much like what we are doing here.” Howard is
16 Beginnings

experiencing the engagement, the partnering, the mutuality, and the explo-
ration between the two of you that reflects the shared responsibility, the
cocreated focus, and the attunement you would want in a hearty alliance—
all without your describing what you do. You lived it instead.4
Historically, the work of planning psychotherapy has organized itself
around establishing a diagnosis or developing a case formulation. We will
explore systematized approaches to both of these methods and examine
their limitations for developing a therapy plan. Neither has intentionally
and systematically addressed the mind-set of understanding as a means of
gathering information. Neither has intentionally and systematically pur-
sued an intertwining of the two mind-sets (the linear diagnosis and the
experiential understanding) as a way of exploring the patient’s experience
and recognizing information held within that experience that is valuable to
planning treatment. And traditionally, neither has systematically partnered
with the patient in developing the plan for treatment.
After we examine how and why the traditional methods of diagnosis and
case formulation fall short when developing a treatment plan, I will offer an
alternative way to approach the task, called mapping. Mapping retains the
linear work of locating parameters of safety and establishing a framework of
facts (diagnosis), and it weaves this necessary linear work into the open expe-
riencing of the patient so that understanding and diagnosis work together to
develop a fuller, richer expression of who our patient is. By moving with the
patient in relationship, one establishes the contours of movement and context
that hold his particular facts and parameters in place. Mapping stays taut
by focusing on what is treatment relevant, stays respectful and mutual by
revolving around growth and development, and expands its problem-solving
abilities by embracing pluralism of theoretical perspectives.

MAKING BEGINNING THERAPY RELEVANT,

GROWTH FOCUSED, AND MULTITHEORETICAL:
CRAFTING AN ALTERNATIVE TO TRADITIONAL
APPROACHES TO PLANNING PSYCHOTHERAPY

The Diagnostic and Statistical Manual of Mental Disorders (DSM;

American Psychiatric Association, 2000) diagnostic system and the case
formulation method are the two most widely used approaches to planning
psychotherapy. Both have endured because each has much to recommend
it. At the same time, each has proven disappointing in identifiable ways.

4 It is important to realize that not all patients are calmed by and feel safer and more trusting
with the mode of understanding; some are made quite uneasy, even disrupted, by it. This
is another reason it is imperative to master both mind-sets: so that one can shift between
them in attunement to clinical needs.
 Understanding and diagnosis 17

DSM
Developing classifications as a way of carving rationality out of the unknown
has a venerable history. Menninger, Mayman, and Pruyser (1963) follow
the systems of classifying symptoms of the mind from as early as 1500
BCE in ancient India, through the Old Testament, the Greeks Hippocrates,
Plato, and Galen, and into modern times. They wryly observe that humans
have an “urge to classify” (p. 14) and that over millennia there has been
a “continual shuffl ing and reshuffl ing of symptoms into various tentative
syndromes and proposed disease entities” (p. 17).
The DSM is relatively young by these standards, having been reworked
over only 70 years (in nearly seven revisions). Its product has been assidu-
ously informed by clinical observation, empirical research, and multisite
conferencing; however, controversy dogs its steps with rising critiques
of cultural bias, politics, and the heavy hand of influential personalities
and pharmaceutical companies (Frances, 2009; Greenberg, 2011; Spiegel,
2002, 2005). The most recent edition, DSM-IV-TR, is nine hundred pages
long, defi nes close to three hundred mental illnesses, has been translated
into 13 languages, and generates on average $6.5 million in sales per year
(Greenberg, 2011; Spiegel, 2005).
It is impossible to ignore the DSM system of diagnosis. It sets standard
of care and is correspondingly referenced with insurance companies and
the legal system. It has been presented as a statistically reliable system—
meaning that, with adequate training, different clinicians can agree with
each other on a DSM diagnosis for a particular patient. Although this claim
is less true for the average clinician in private practice than it is in research
settings where training in the use of a lengthy, structured interview is pre-
requisite for diagnosing (Herzig and Licht, 2006; Kutchins & Kirk, 1997;
Spiegel, 2005), 5 the DSM nonetheless remains widely used. Because it is
centered on observable behaviors, it offers a rough advantage to clinicians
who need to communicate with each other efficiently across varying edu-
cational degrees, experience, theoretical persuasions, or even languages.
The DSM roughly helps us “locate” the patient. Such broad categories
as mood disorder, adjustment reaction, schizophrenia, delirium, posttrau-
matic stress disorder, and so on do present different treatment implications.
Although Holt (1968) clarifies that “diagnoses are not addresses of build-
ings into which people may be put, but landmarks with respect to which
people may be located” (p. 14), sighting landmarks remains an important
fi rst step in knowing where we are so we can plot where to go.
Having a method for identifying variables relevant to maintaining safety
and initiating adjunctive procedures is good patient care, as we discussed

5 The forthcoming DSM-5 is incorporating a study design in its field trials that will attempt
to measure the reliability of DSM when used by individual clinicians and in smaller clinical
practices (Clay, 2011).
18 Beginnings

earlier when we spoke about Howard. The treatment implications of vari-

ous DSM categories help us flag issues requiring urgent attention and
additional interventions (e.g., hospitalization, medication, tracking envi-
ronmental safety, attending to substance use, considering the effects of
malnutrition, communicating with people in the patient’s life, accelerating
the timing of the next session, requesting neurological or other adjunct
consultations, and so forth).
Exercising diagnostic thinking when beginning thus helps us recognize
severity, communicate efficiently, and attend to the patient’s safety and
thorough care. However, a drawback to utilizing the DSM system of diag-
nostic thinking is that it omits categories that are necessary to developing
a treatment plan (Barron, 1998). We must supplement the DSM’s catego-
ries with categories relevant to where we begin in psychotherapy and why.
For example (extending Holt’s metaphor), knowing Kelly is depressed
(DSM) locates a general landmark; knowing which sort of developmental
disruption is driving her depression moves us from general landmark to
particular neighborhood—one that will inform which paradigm therapy
will follow. Similarly, understanding the categories of internal psycholog-
ical structures and their courses of healthy development helps us identify
the presence of structural vulnerabilities in Kelly that might create stum-
bling blocks in her therapy process. When places of structural weakness
are recognized, we include in Kelly’s treatment planning a search for the
conditions that tap her weakness and those that reliably help her recover
from disruption.
Another drawback to the DSM system of diagnostic thinking deserves its
own section since this drawback is not exclusive to DSM. In the following
discussion, we will consider the downside to organizing the comprehension
of a person exclusively around pathology.

The invisible damage from

organizing around pathology
[Certain] schools [of theory], to my way of thinking, deserve reproach
for over-emphasizing the pathological aspect of life and for interpreting
man too exclusively in the light of his defects.
Carl Jung (1993, p. 117)

A silent toxin in many existing methods of classification and case formu-

lation is the tendency to view behavior, suffering, symptoms, and their
resolution exclusively through the lens of pathology. Consider typical
words used in discussions and write-ups across theoretical persuasions:
disorder, personality disorder, dysfunctional, oppositional, enmeshed,
OCD, defi ant, symbiotic, pathological, defi cient, disturbed, resistant,
infantile, needy, passive-aggressive, narcissistic, and so forth. These types
 Understanding and diagnosis 19

of words have become embedded in our mental health culture. As touched

on in Chapter 1, experienced clinicians understand how such words limit
empathic and creative thinking. Words like these promise explanation,
but in fact oversimplify and truncate exploration. Furthermore, using
them subtly damages the patient’s developing mind and sense of self (both
of which are exquisitely open to influence during psychotherapy). The
patient quietly internalizes implicit judgmental and derogatory attitudes
toward him, which color the story he holds of himself, constrict what he
lets himself show us or see himself, and limit who he can imagine himself
becoming.
A silent toxin of this nature is of serious concern given that we are in the
growth business. Karl Menninger, an influential American psychiatrist and
cofounder of the Menninger Clinic, illustrates this point when he quotes a
colleague, Henry Davidson (Menninger, Mayman, & Pruyser, 1963):

From our residents’ lounge, the other day, came a mish-mash of morbid
words: anal … aggressive … guilt … acting out … genitals … hostile.
The psychiatric lexicon is indeed loaded with words which make the
ordinary fellow blush or bristle. Sometimes the patient must think we
look down our noses at him. How else is he to react to words like
“infantile” or “aggressive”? … Whatever meaning they convey to the
sophisticate, these are scolding words to the average man… . Probing
the depths of the mind should surely reveal wellsprings of idealism,
courage, and nobility… . Yet somehow the idiom of psychiatry seems
to the average man to be overloaded with words of insult, reproof, or
gloom. (p. 44)

Menninger and his colleagues go on to say: “Patients who consult us

because of their suffering and their distress and their disability have every
right to resent being plastered with a damning index tab. Our function is to
help these people, not to further affl ict them” (p. 47).
It is difficult to escape labels. Their shorthand is compelling. This is par-
ticularly true when we are exhausted by the work of maintaining compas-
sion and holding complexity. At those times, we are vulnerable to thinking
in reductionistic, implicitly pejorative terms about our patients as expres-
sion of our fatigue or helplessness. If we have been trained in approaches
that seek to help with suffering by focusing on what is wrong, we are less
familiar with looking for what might be right.
We can strive, nevertheless, to recognize when we are falling into think-
ing that narrows thought and to be mindful of the impact on our patient.
When we focus our perceptions, listening, thinking, and goals through
the lens of pathology-centric terms (however benevolently motivated), our
patient becomes imprisoned in patienthood rather than in growth, and we
model intimacy based on hierarchy rather than on mutuality. Our patient’s
20 Beginnings

capacities tend to settle in the backwaters of conversation. We steer our-

selves away from appreciating symptoms as creative solutions, choices
for survival, and active efforts to keep development going. Instead of our
patient’s mastery staying front and center as admirable, the focus slides
onto our patient’s feelings of failure and mistake-making instead. Letting
the therapy ride such a course over time locks in our patient’s recurrent
view of himself as falling down rather than seeing himself in his mind’s
eye as learning to walk. The former carries a shadow of discouragement,
the latter a sense of hope and perspective. The pictures our patient sees in
his mind shape the sense of self he carries into his future more than do our
verbal exhortations, because the visually implicit cannot be consciously,
intellectually disputed.
I am not suggesting an entire revamping of the language of mental health.
Arguably, doing so would be a misplacement of energy for many reasons, one
of which is that language can shift but pejorative attitudes of disparagement
will always be with us. Such is human nature. The default state in our brain
is a binary one of extremes. When we are depleted or threatened, we more
readily fall into simplistic concepts and either-or thinking. Our best inocula-
tion, thus, is a shift in awareness rather than focusing too singly on a shift in
terms. The latter risks becoming a cosmetic change only. A shift in awareness,
in contrast, would entail being mindful that therapy’s essence is learning and
growth, that how we language our interventions is an intervention, and that
the implicits eventually define the outer limits of change for our patients.

Case formulation
It is diagnosis in the sense of understanding just how the patient is ill and
how ill the patient is, how he became ill and how his illness serves him.
From this knowledge one may draw logical conclusions regarding how
changes might be brought about in or around the patient which would
affect his illness.
Karl Menninger, Martin Mayman, and Paul Pruyser
The Vital Balance (1963, p. 7)
The case formulation method strives to go beyond classification to gener-
ating a picture of the person and his context. In this method, one gathers
historical data and elaborates hypotheses, in the form of a narrative, about
the predisposing, precipitating, and perpetuating influences on the patient’s
current distress (Kline & Cameron, 1978). The model has its roots in the
medical case history, dating back to Hippocratic and Galenic medicine in
the fourth and fi fth centuries bce (Eells, 1997). More than 2,000 years
later, as Ellenberger (1970) has noted, the psychiatric case studies of Janet,
Breuer and Freud, Jung, and Adler built on that case history format, and
Karl Menninger (1952) systematized the method in his landmark book, A
Manual for Psychiatric Case Study.
 Understanding and diagnosis 21

Menninger’s (1952) exhaustive outline for history-taking included (but

was not limited to) information about hereditary influences, labor and
delivery, developmental milestones, family and extended family history
(including sibling relationships, discipline practices, and parental attitudes
toward the person), physical influences (accidents, operations, illnesses),
academic history, job history, relationship history, sexual history, history of
the presenting symptom, course of illness, style of stress management (i.e.,
defensive operations), factors precipitating the consultation, reactions of
others to him, and attitudes toward seeking and receiving help. From this
information, a diagnosis, prognosis, and treatment plan were formulated
and presented to the patient.
Menninger’s approach is at the core of most case formulation meth-
ods that followed, be they psychodynamic (Cameron, Kline, Korenblum,
Seltzer, & Small, 1978; Friedman & Lister, 1987; Kline & Cameron, 1978;
McWilliams, 1999; Messer & Wolitzky, 1997; PDM Task Force, 2006;
Sperry, Gudeman, Blackwell, & Faulkner, 1992), cognitive-behavioral
(Kuyken, Padesky, & Dudley, 2009; Needleman, 1999, 2005; Nezu, Nezu,
Friedman, & Haynes, 1997), or integrative (Caspar, 1997; Horowitz,
1997; Horowitz & Eells, 2010; Ingram, 2006; Weerasekera, 1996). Since
the fi rst edition of this book (Peebles-Kleiger, 2002), the case formulation
approach has continued to be updated (e.g., Eells, 2006; Persons, 2006;
Sim, Gwee, & Bateman, 2005). Neurodevelopmentally informed models
of case formulation are being proposed that seek integration among fi nd-
ings from molecular genetics, neuroimaging, and knowledge of brain func-
tioning and plasticity when planning treatment (e.g., Reiss, 2010; Siegel,
2010b; Solomon, Hessl, Chiu, Olsen, & Hendren, 2009).
Different methods of case formulation have in common a striving to cap-
ture what is unique to the patient, to be comprehensive, to offer outlines for
gathering information, and to teach the fundamentals of their particular
theories. However, despite providing an expanded picture of the person
seeking treatment, traditional case formulation methods bring limitations
to the therapy planning process. Looking at these limitations carefully
instructs us in how we might improve on the methodology while preserv-
ing its emphasis on our patient’s story and context.

• Cumbersome comprehensiveness: One of the strengths of case

formulation—its comprehensiveness—can become one of its limita-
tions. The format sometimes becomes time-consuming and overtakes
the opportunity for understanding from inside our patient’s experi-
ence. Furthermore, whether the time spent is worth the clinical use-
fulness of the extensive information gathered remains a continual
question.
• Not always relevant to treatment: Not all historical facts inform
the way we will work clinically with the patient. Some information
22 Beginnings

gathered in case formulation could be left to discovery during the

course of therapy. Additionally, there is the vexing particular that
often the information gathered is organized by the framework of the
therapist’s theory rather than by the organic organization of the patient
and his story (see Dahl, 1983; Rosenhan, 1973; Shectman, 1973).
• Patient as passive participant: The method of gathering information
in case formulation can unintentionally diminish authentic engage-
ment as well as reinforce the passivity of the patient. That is, by hav-
ing predetermined questions that need answering, the therapist can
lose sight of listening and being with the patient—two essentials of
understanding. Further, he can move into a role of extracting infor-
mation, with the patient acquiescing by passively giving information.
The opportunity to enlist the patient as an active diagnostic partner
who is puzzled and pondering as well is then easily lost (Shevrin &
Shectman, 1973).
• Monotheoretical: Most models of case formulation (with a few excep-
tions) are wedded to a single theoretical school, confi ning their use to
students of that school. Patients benefit from having the wisdom of
multiple theoretical perspectives in play when therapy interventions
are being planned.
• Difficulty with synthesis: The most serious drawback to the case for-
mulation method is that the step of synthesis or formulation (i.e., con-
verting the extensive data collected into treatment method, sequence
of focuses, and particulars of alliance) is the most difficult step to
master and frequently is not accomplished. Systematizing how to gen-
erate treatment implications from pages of notes created by a largely
preselected set of questions and formats is challenging. Although
experts tend to succeed at translating interview data into implica-
tions for treatment (Eells et al., 2011), this skill is difficult to teach to
novices (Cruz & Pincus, 2002; Ivey, 2006; Ross, Leichner, Matas, &
Anderson, 1990; Toews, 1993).
While surveys of Canadian, American, and British psychiat-
ric residency programs have found that 60 percent (Ben-Aron &
McCormick, 1980) to 97 percent (Friedman & Lister, 1987) of the
programs believe case formulation is an important skill to learn, only
40 percent (Ben-Aron & McCormick, 1980 [Canada]) to 31 per-
cent (Fleming & Patterson, 1993 [Canada]) to as low as 5 percent
(Friedman & Lister, 1987 [United States]) of the residency training
programs queried in the surveys provide written guidelines to their
trainees detailing how to take this fi nal step of synthesis. Most of the
schools provide no published references to read on the topic of case
formulation (Ben-Aron & McCormick, 1980; Friedman & Lister,
1987). These facts may explain why the step of synthesis is frequently
left out of clinical intake write-ups.
 Understanding and diagnosis 23

One study found that only 5 percent of the intake summaries

reviewed went beyond recounting historical facts to adequately syn-
thesizing them into a formulation that linked symptom to etiology,
much less etiology to treatment (Eells, Kendjelic, & Lucas, 1998).
What this translates into is thousands, if not millions, of hours spent
collecting data in psychiatric clinics and offices across the country,
ostensibly to plan treatment, but with little sense of direction for how
to use those data to sculpt the actual shape the treatment will take.
Even when one does craft treatment implications based on data
collected, how one puts the historical facts together into a cause-and-
effect picture varies according to one’s theoretical school and style
of reasoning. Clinicians within the same theoretical school have
shown low agreement in their formulation of a patient’s difficulties
(Collins & Messer, 1991; Seitz, 1966).

To summarize, case formulation, compared to classificatory systems

like that of DSM, more fully captures the uniqueness and complexity of a
patient. The model, however, still does not sufficiently expand beyond the
left-directed classificatory thinking of diagnosis to include systematic ways
of utilizing the right-directed experiencing of understanding to enrich data
gathering. It has not found a satisfactory way to translate the data it does
gather into specific implications for treatment.
A different paradigm is needed—one that shifts the mode of inquiry from
case history to spontaneous story, while retaining frame and rigor in the
process. One that offers a scaffold for culling the rich information that lies
within the actual relationship between patient and clinician. One that holds
a taut focus on seeking treatment-relevant data. One that remains growth
focused. And one that takes advantage of multiple theoretical perspectives.

MAPPING: AN ALTERNATIVE PARADIGM

As I said in the opening of this chapter, the art in beginning is to be able

to move securely around, between, and inside both modes of mental
awareness—diagnosis and understanding. How do we hold a linear, locat-
ing frame of mind with an open, listening, moving-with-and-into frame of
mind so that the patient can rest assured his expressions within each are
being heard sufficiently?
I’m going to suggest a way of thinking and method of inquiry that I
call mapping. Mapping stays true to our metaphor from Chapter 1 that
when a patient comes to us, he is asking us to go into the woods with
him—to help him complete his journey through those woods whatever
his particular woods happens to be. We learn where he is only by going
with him into his unknown (understanding). But we must take with us
24 Beginnings

our orienteering skills (diagnosis) in order to help him emerge intact and
transformed on the other side without our both becoming swallowed by
his woods.
Mapping integrates linear categorizing with nonlinear experiencing.
Our map evolves from sampling our patient’s journey in order to direct
his journey further. We enlist our patient as partner—his eyes see different
things than our eyes can. We remember maps we have encountered before.
But the map we create with each patient is unique. The patient and we draw
its contours together after traversing a few initial sessions together. The
map becomes the plan for psychotherapy.

Spontaneous story instead of case history

Mapping understands the centrality of story and context. We move inside
our patient’s “house” (through its rooms, its layout, the structural integ-
rity, the décor) as a way of learning the essence of our patient and what he
needs. Our patient is our tour guide; we are the invited guest, respectfully
interested in the smallest photo and the story behind how it came to be on
that particular wall.
Pink (2005) describes growing recognition in physical medicine of the
value of an emphasis on story. He describes Dr. Rita Charon, a professor
from Columbia University Medical School, “attempting to place story at the
heart of diagnosis and healing” (p. 112). He quotes Dr. Howard Brody, a
family practice physician, as saying: “Our ability as doctors to treat and heal
is bound up in our ability to accurately perceive a patient’s story” (p. 112;
emphasis added).
Mapping emphasizes our patient’s spontaneous story as the vessel hold-
ing what is most meaningful in this moment to our patient. By “sponta-
neous story,” I mean the stories that arise organically as the patient and
clinician engage with each other, rather than the narratives constructed
from answers to a preset outline (i.e., the “case history” in case formula-
tion). We learn how to elicit spontaneous stories and how to recognize their
important information.

A method for appreciating the data

held within relationship
Several chapters in this book (6–10) describe the “process approach.”
This is a method of inquiry that appreciates that information essential to
understanding our patient’s suffering and the reasons he is stuck inside
his suffering is locked inside implicit, procedural memory and thus can
only be enacted rather than described. To unlock that information, we
must allow our patient to show us what is wrong rather than constrict-
ing him only to describing it. The process approach provides a format
 Understanding and diagnosis 25

for engaging in relationship with our patient in such a way that we learn
from the inside out what is troubling him and what gets in the way of
his solving it. The method of the process approach brings structure to
understanding.

Treatment relevance as focal point

Comprehensiveness can obfuscate relevance. Knowing details about
strengthening our patient’s alliance, the developmental disruptions driv-
ing his symptoms, his structural vulnerabilities, his strengths, and his
learning style makes concrete differences in how we proceed in psycho-
therapy whatever our theoretical orientation. This is the information we
map when beginning. In the initial sessions with our patient, we consis-
tently return to this focal point: What does this (information, behavior,
feeling, puzzle, question, answer) tell me about how I will proceed in
treatment?

Growth and development as our lens

Probing the depths of the mind should surely reveal wellsprings of ideal-
ism, courage, and nobility.
Karl Menninger, Martin Mayman, and Paul Pruyser
The Vital Balance (1963, p. 44)
Earlier, I described the hazards of organizing diagnosis and understand-
ing around pathology. What, then, is the alternative? It is contextualizing
mapping within the framework of development and growth. This means
assuming that what the person has done in life has made sense—even if
he or we do not yet know what that sense is. It means his choices held a
kind of wisdom. And it means he came into this life with innate strengths.
Our job is to understand the sense, appreciate the wisdom, and discover
and anchor the work in the strengths. How has the person in front of us
grown, survived, protected, adapted, contributed, and created? What can
we do to nurture now what is best in him so that he might grow more,
grow again, or grow in a direction that will bring him more joy and less
pain?
Sometimes our silent attitudes toward ourselves can get in the way of
focusing on our patient’s strengths. It is interesting that how we treat our-
selves gets repeated in how we treat our patients—harsh self-judgments
are associated with criticizing and focusing on the failings of our patients
(Henry & Strupp, 1994; Henry, Strupp, Butler, Schacht, & Binder, 1993;
Hilliard, Henry, & Strupp, 2000). When our acceptance and compassion
toward ourselves grows, it becomes easier to understand that “we are more
alike (our patients) than different” (P. Novotny, personal communication,
26 Beginnings

1978), or as Harry Stack Sullivan (1953) put it, “We are all much more
simply human than otherwise, be we happy and successful, contented and
detached, miserable and mentally disordered, or whatever” (p. xviii). It is
then we can start to see that our patient is a person with innate capacities
(like us), who was knocked from a path of undamaged growth by unfor-
tunate circumstances, further complicated by understandable survival
mechanisms (like probably we at times have been). We become less com-
fortable with pathologizing his tribulations and more able to hold in mind
his strengths. We partner with him to access his strengths through his suf-
fering, so that he can return to his track of becoming all that he might have
become or was on his way to becoming before his development became
twisted, blocked, or snagged.

The advantages of pluralism: A theory

of simultaneous truths
Mapping strives to cull treatment-relevant concepts that synchronize with
multiple theoretical perspectives (e.g., Castonguay, Boswell, Constantino,
Goldfried, & Hill, 2010). Our patient benefits when we can be “multilin-
gual” when planning psychotherapy.
We know that each major theoretical school (biological, behavioral, psy-
chodynamic, cognitive, humanistic, systemic) contains its own set of evolv-
ing truths about human functioning, development, and treatment (see, e.g.,
Table 5.1; Truscott, 2011). When we draw upon the cumulative wisdom
of multiple perspectives, our patient is rewarded with richer treatment
planning (Gabbard & Westen, 2003; Peebles-Kleiger, 2001a; Pine, 1990;
1998). This point of view is neither atheoretical nor eclectic; it is pluralistic
or, one could say, a theory of simultaneous truths. A pluralistic theory of
simultaneous truths allows multiple psychological explanations to coexist
as equally valid. An explanatory formulation from one theoretical perspec-
tive does not invalidate explanatory formulations from other theoretical
perspectives.
In 1927, Niels Bohr proposed the principle of complementarity in phys-
ics to explain how electrons could behave both as waves and as particles.
He asserted: “No one picture of nature provides a complete description of
quantum phenomena… . Mutually exclusive but complementary pictures
must be invoked, depending on the … situation” (Siegfried, 2010a, p. 16).6
The well-known figure/ground perceptual puzzles of two silhouettes
embedded within a single image (face or vase, young woman or old crone;
e.g., see Hendee, 1987) or the popular M. C. Escher prints (staircases

6 For another author’s evocation of Bohr’s theory of complementarity to describe different

perspectives in mental health, see Frattaroli’s (2001) commentary on integrating the “medi-
cal model” with the “psychotherapeutic model.”
 Understanding and diagnosis 27

simultaneously leading in opposite directions) present visual metaphors of

the same principle of simultaneous explanatory realities. In those percep-
tual mind-stretchers, independent, alternative images are simultaneously
present; each holds a different conceptual or emotional meaning, yet both
are “true.” Which image is perceived depends on the moment’s vantage
point of perception.
Similarly, alternative theoretical explanations (psychological realities) of
a patient’s situation can coexist and be equally valid (one enriching the
other) rather than competing for validity. In any one therapeutic moment,
words, logic, action, emotion, physical experience, and social context all
play a role in our patient’s expression and in our efforts to effect change,
with varying degrees of relevance or ascendancy. Which explanation is
emphasized depends on the locus of clinical pressure in the moment.

NEXT STEPS

There is a tension to feeling the heartbeat of an encounter, while simultane-

ously analyzing the location of pitfalls. In truth, there is a parallel process
of tension in trying to convey to you, through the linearity of the written
word, the sensation of opening oneself fully to experiencing while simul-
taneously tracking and organizing one’s experience. Sometimes one’s mind
toggles between the two states of receiving. In other moments, both mind-
sets of understanding and diagnosis permeate each other as if transparent
layers are being superimposed and each can be seen through the other.
Feeling tension when trying to sustain awareness of experiencing and orga-
nizing is normal. Tolerating this tension is worth it, because doing so ben-
efits the patient.
At fi rst, one may be able to attend only to diagnosis (e.g., places of devel-
opmental disruption, relative levels of structural capacities). Doing so is
still useful, because there is much to learn in the diagnostic nooks and
crannies—many essential elements to recognize and track. But keep in
mind the person and the heartbeat. Remember the suffering. As the cat-
egories to diagnose become more familiar to us, we relax more into under-
standing and listening. We are able to allow ourselves expanded awareness
of our bodily, visceral, and imagistic sensations even while our left-directed
analytic mind continues to track details and organize conceptual scaffolds.
Decades ago, Carl Jung (Jung, Franz, Henderson, Jacobi, & Jaffe, 1964)
summarized one of the core tenets of his life’s work: that only by learn-
ing how to integrate and complement one’s conscious cogitations with
one’s vital and rich “unconscious” ways of symbolically and imagistically
knowing and organizing could a person express his fullest and most fer-
tile self. Later, in psychodynamic circles, this accomplishment was called
allowing the “observing ego” to be present alongside the “experiencing
28 Beginnings

ego” (Fenichel, 1939; Rangell, 1955). Nowadays, the order and terms have
been reversed, and people are restoring belief in the potency of understand-
ing (e.g., the “‘right-brain’ qualities of inventiveness, empathy, joyfulness,
and meaning” [Pink, 2005, p. 3]) when allowed not simply alongside but
actually ahead of “left-brain” qualities of logical, analytical sequencing
(Pink, 2005).
Let us continue holding this tension of left-brain, observing, analytic,
diagnostic thinking simultaneous with right-brain, experiencing, intuitive
understanding while we pursue exploring what is enough to know to begin
psychotherapy. In the following chapters, we will address mapping and the
process approach as methods for integrating diagnosis and understanding
into a form of treatment planning that is treatment focused, grounded in
development and growth, and multitheoretical.
Chapter 3

Mapping

Everything should be made as simple as it can be, but not simpler.

Albert Einstein

We have made an effort to enter Howard’s world—to move into the details
of what immovability feels like when it’s the fi rst thing that greets him in
the morning. We have kept an ear open to the sapping of his energy, explor-
ing if and how we need to attend to his safety both in this initial process
and in ongoing therapy.
But what is the big picture? We are entering into relationship. We are
gathering details. Where do we go next? What should we comment on,
inquire about, introduce? Should we just listen and trust that what is
important will emerge? Or are there questions in these fi rst sessions that
will make a meaningful difference to our patient’s treatment plan?
I am of the mind that what we inquire into matters because one (treatment)
size does not fit all. (If it did, what would be the point of diagnosis?) My
view is not new. It has been voiced since psychiatry’s inception. It has been
empirically researched nearly as long, with efforts beginning to gain trac-
tion in the 1950s (e.g., Eysenck, 1952; Luborsky, 1954; Wallerstein, Robbins,
Sargent, & Luborsky, 1956). It was 45 years ago that Paul (1967) succinctly
summarized the challenge-question that organized decades of subsequent
psychotherapy outcome research, namely, “What treatment, by whom, is
most effective for this individual with that specific problem, and under which
set of circumstances?” (p. 111, emphasis in original). This commitment—
to examining details of the match between approach and patient—becomes
even more pressing when one also considers the research into the harmful
effects that psychotherapy can have (e.g., Castonguay, Boswell, et al., 2010;
Peebles, 2010; Strupp, Hadley, & Gomes-Schwartz, 1977).
Thus, therapy does and should vary—and in more ways than mere varia-
tions among theoretical perspectives or particular modalities. It is the
variations in the details—of focus, sequencing, attunement, and timing—
that affect outcome and make the identical modality quite different in its
unfolding from one patient to the next.

29
30 Beginnings

Practically speaking, let’s say a therapist offered only cognitive-behavioral

therapy. When Howard comes to that therapist seeking help, he deserves
her considering whether or not her type of therapy was the best choice for
him. Yet how would she make that determination? Elaborating further,
let’s say the cognitive-behavioral therapist determines Howard and Kelly
are perfect matches for her modality. If the therapist is experienced, it is
unlikely she will proceed in the same way with Howard as she does with
Kelly—even though both may be depressed! If the therapist is experienced,
she will adjust her approach according to variations between Howard and
Kelly such as the following:

• What allows Howard to trust and what makes him wary will be
different than Kelly’s rhythms of trust and fear; thus, particulars of
establishing alliance with each will differ.
• The underlying disruption in development driving Howard’s depres-
sion will vary from Kelly’s. Accordingly, the focus of the work will
differ.
• The places of mental and emotional vulnerability and strength in
each will vary, thus changing the sequencing and timing of topics and
types of interventions.
• Howard may learn in a way that is very different from the way Kelly
learns. If the therapist attunes to learning differences, her “teaching”
style will differ. She will vary in whether she leans on metaphors,
imagery, quantitative empirically derived data, kinesthetics, intellec-
tualized concepts, sensory cues, and so forth when she speaks with
Howard versus Kelly.

The important point for beginning is this: We can gather information in

the initial sessions that guides us in making distinctions not simply among
modalities but, more importantly, also among certain particulars that
sculpt the shape of the therapy whatever the modality or theoretical orien-
tation. These distinctions will make a difference—as to whether Howard
stays or leaves and whether Kelly feels that she is gaining something or feels
unsure about what the therapy is doing and where she is in the work.
How might we organize distinctions that cut across theoretical orienta-
tion and are relevant to how we proceed in therapy?
First, to keep things simple but not simpler than they can be, there are
four essentials to learn about in the beginning that will make immediate
and concrete differences in what we do in therapy and when:

1. Alliance
2. Focus
3. Vulnerabilities and strengths
4. Learning style
 Mapping 31

It is these essentials that we want to map.

Second, mapping involves formulating ideas about these essentials not as
mental frameworks with linear grids or continua but instead as contours,
on dimensional topography with if-then possibilities, that comprise simu-
lations. When we map for a psychotherapy treatment, we are creating a
picture of an open system—a model for a process—for which closed-form,
analytically derived statements are insufficient for capturing what might
take place. In psychotherapy, multiple variables and complex interactions
affect the moment-to-moment decisions during the work. Thus, planning
psychotherapy necessitates a contoured simulation model rather than a grid
or category model.
Third, in order to create a map with such contours, we must enter into
relationship with the patient and experience the dimensions and the flow
through time, in real time, of the four essentials listed above. To estab-
lish their topography and their if-then potential for malleability, we must
engage the patient in examining what is happening between us and offer
feedback, encourage reflection, and track the impact of our different invita-
tions and interventions on the contours of the next relational moment and
on the patient’s next display of capacity or vulnerability.
This is what mapping is: learning certain essentials, in a contoured, if-
then picture, through mutual engagement with the patient in the process.
The end result is creating partnership and commitment with the patient and
crafting together what our work will be, how we can do it safely, and how
we will protect respect, nourish trust, and culture realistic hope.

THE ESSENTIALS

Alliance
Alliance is the most important variable to consider when mapping a plan
for psychotherapy because it is the most robust predictor of positive (or
negative) outcome across theoretical orientations. Practically speaking, the
most sophisticated treatment plan will be worth little if our patient has left
treatment. It could be argued that the strength of the alliance is a better
prognosticator of whether or not a patient will recover from destabiliza-
tion in psychotherapy than how severe the patient’s destabilization actually
is. The alliance—the relationship between therapist and patient—can be a
saving bridge across a chasm of vulnerabilities. When the alliance is weak
or negative, no number of capacities and strengths can move the patient
into partnering around change.
Alliance is not one-dimensional. It is composed of multiple threads such
as the capacity to trust, the ability to receive help, the current stress in one’s
life, the ability to bring thinking online when feeling strong emotion, and
engrams of past experiences that create a web of relational expectations, to
32 Beginnings

name a few. Thus, we need to attune to variations across aspects of alliance

rather than state too simplistically that a patient can or cannot establish an
alliance.
Alliance is not a static capacity. It expands and contracts and alters in
hue and tone depending on the content of the discussion, the voice tone and
inflection of the therapist, the emotions being tapped, the degree of sleep
one had the previous night, and many other variables. Thus we need to map
the quality of the alliance across different circumstances.
Alliance is relational, not solitary. The nature of the alliance varies,
depending on the dynamic created between the particular two people who
are working together. Consequently, we need to consider how the patient’s
ability to receive help and work mutually varies across people.
Finally, and perhaps most importantly, alliance is not simply a matter of
helping the patient feel a positive experience of comfort and trust. More
challengingly, alliance is about the ability to catch and repair the inevitable
micro- and macroruptures that will occur in the most benign of trusting
relationships over time, content, emotion, and self-states (for both therapist
and patient!). Thus, when we track the capacities for alliance during the
initial sessions, we pay special attention not only to if and when ruptures
may occur but also to the conditions under which these ruptures can be
repaired.
Ideally, in any positive therapeutic encounter, the capacity for alliance
and intimacy grows over time. Like with muscles, it is the repairing of
small tears that grows intimacy’s sturdiness. It is the repetition of repair
over time that grows intimacy’s durability. Thus, when thinking about alli-
ance, we also want to notice our patient’s overall capacity for awareness
of her impact on others and of theirs on her and how curious and open (as
opposed to ashamed) she can become about such awareness. We are inter-
ested in what conditions enhance our patient’s willingness to explore here-
and-now relational nuances. Our patient’s openness to relational awareness
is necessary for repairing the misunderstandings that turn up.
We will look more at mapping alliance in Chapters 4, 17, and 20.

Focus
Focus comes in a close second to alliance in terms of features essential to
map when planning psychotherapy. We will discuss several reasons why
in Chapter 5. Suffice it to say here that, across theoretical orientations,
one factor recurrently associated with the floundering of a therapy is inad-
equate assessment leading to inaccurate focus (Castonguay, Boswell, et al.,
2010; Strupp et al., 1977).
In this book, focus refers to the goals of the psychotherapy, but goals
that are established in a more complex way than simply by citing the
patient’s chief complaint. The chief complaint is just the starting point for
 Mapping 33

developing a working theory about what is driving the suffering expressed

by that complaint.
As an analogy, to adequately treat fever we must decipher what is caus-
ing the body to elevate its temperature. Is it bacteria? A virus? Parasites?
If so, which ones and where? Food poisoning? Arthritis? Heat exhaustion/
dehydration? There are literally several thousands of conditions that can
present with fever, varying in severity from annoying (e.g., the common
cold) to rapidly deadly (e.g., meningitis). We stabilize the fever when its
level is disruptive; however, subsequent treatment hinges on identifying the
underlying reasons the fever is in process.
Similarly, when mapping focus, we want to follow the chief complaint
back to the disruptions driving that complaint. We can think of disruptions
in development as falling roughly into four groupings, each of which points
us toward a different treatment paradigm. The four groupings are:

1. Structural weakness
2. Trauma
3. Habitual mental and behavioral solutions that become maladaptive
4. Constriction of access to internal voices and aspects of self1

The treatment paradigms that correspond with these four groups are:

1. Structural repair
2. Trauma work
3. Loosening and shifting behavioral and mental habits
4. Opening simultaneous access to varying internal states and views

When working within a treatment paradigm, the content, timing, and

emphasis vary among different patient–therapist partnerships. In addi-
tion, the interventions selected to carry the work forward vary according
to the patient’s learning style, the patient’s pattern of vulnerabilities and
strengths, and the therapist’s theoretical orientation. However, the central
task of each paradigm remains the same across theoretical orientations and
interventions (see Chapter 11). As part of creating focus for the psychother-
apy, the clinician maps the underlying disruption paradigms that are driv-
ing his patient’s symptoms. He does this by sketching the external events,
the internal processes, and the efforts at recovery and protection that are
interacting to create the patient’s pain. He then considers which contribu-
tions to the patient’s suffering reflect structural vulnerability, which reflect
trauma, which the muffl ing of personal voice, and which the working of
mental habits that have outlived their original usefulness. In doing this, he
develops a map that identifies clear treatment directions.

1 The four models of underlying disruption are described in more detail in Chapters 11 and
13–16.
34 Beginnings

Taking into account two additional factors customizes the directions for
treatment further. First, we recognize what has been adaptive about our
patient’s symptoms and what important functions they have served so that
we accordingly might build new, healthier adaptations into her therapy
plan. When risking change, our patient needs a floor to step onto as she
leaves what has been familiar. Appreciating the difficulties to which our
patient would be exposed as she relinquishes her symptoms helps us build
such a floor into her treatment plan (see Chapter 22).
Second, everyone brings built-in expectations of what change will feel
like and what a process of psychotherapy will be. Discovering our patient’s
expectations for therapy, and aligning reality with her anticipations by
tweaking in both directions, is another important way we fi ne-tune her
treatment plan’s focus (see Chapter 24).
The astute reader may recognize a left-directed thinking style in the con-
sideration of four treatment paradigms corresponding with four types of
developmental disruption. As discussed in earlier chapters, the locating
function of categorizing can be useful as long as it is not relied upon rigidly
or exclusively or substituted for understanding. To avoid a brittleness to the
mapping, resulting from splitting hairs when trying to determine catego-
ries of disruption, it is important to remember that most patients struggle
in more than one place of disruption. Development is dynamic. Processes
affect and spawn each other as we circulate through disruption, protection,
and recovery.
Consider what happens when a young girl is struck with chronic
migraines and, in response, reflexively hunches her shoulders and neck to
brace against the pain in her head. Eventually, the cramping of muscles in
her shoulders and neck create a pain of their own, which radiates up her
neck, causing now a tension headache layered atop her migraine. Irritability
and discouragement ensue. The physical pain and the agitating emotions
dysregulate her sleep, and the resulting exhaustion lowers her threshold
further for more migraines. She learns that being upset emotionally makes
things worse, so she develops a practice of denying her upset and minimiz-
ing the relevance of disruptive events. Her style of denial and pushing away
conflict becomes habitual and, several years later—long past the time that
her migraines eventually abated—she is perplexed at her difficulty navigat-
ing friendships.
This young girl, like each of us, is a miniecosystem—her disruptions cre-
ated solutions, some of which created new disruptions, which in turn drove
new solutions. Her difficulties with friends are a result of both structural
weaknesses biologically (the migraines) and maladaptive character patterns
(her rigid denial and minimization). The two paradigms of disruption are
not either-or categories. Multiple processes interweave, and the sophisti-
cated clinician considers how best to sequence and interconnect the parts
of the work, both across and within sessions.
 Mapping 35

Vulnerabilities and strengths

How many times have you relied on a navigation system or good road map
to show the shortest way from here to there, only to fi nd yourself delayed
for two hours by construction or stopped altogether by a flat tire from a
patch of serious potholes? The fastest route is not always the shortest dis-
tance between two points. As an example of our metaphor, we may accu-
rately determine that Howard needs education in sleep hygiene to reverse
his feeling bedridden in the morning—a straightforward, brief process
on the face of things. However, if we have neglected mapping places of
Howard’s vulnerabilities, we could experience that brief process turning
into an unexpectedly long journey when Howard becomes suspicious of
our questions about bedtime practices and concludes (outside our aware-
ness) that we are self-servingly trying to entrap him in an entangled, voy-
euristically gratifying relationship. He might drop out of treatment without
returning messages, leave a negative report about us on an Internet website,
or return to the next session increasingly symptomatic. Such dramatic sur-
prises are rare, but they can occur when we jump too enthusiastically to
interventions before considering the stumbling places in the terrain of the
person with whom we are intervening.
Thus, when planning psychotherapy, it is essential to map the places of
psychological vulnerability across our patient’s terrain, along with condi-
tions under which these vulnerabilities tend to be activated (see Chapters
17–21). It is equally essential to map our patient’s capacities and resources
upon which we can draw when she encounters an unexpected slip or fall
(see Chapter 12). As will be discussed in later chapters, we not only map
where our patient could get disrupted but also how aware she is of being
disrupted, how she feels about herself when she gets disrupted, her usual
way of recovering from disruption, and what helps her access her strengths
during moments of disruption.

Learning style
Psychotherapy facilitates change and growth. As such, it is a form
of learning—emotional, behavioral, visceral, and even (hopefully)
neurochemical-neurostructural. People differ in the ways they learn best.
Mapping our patient’s learning needs and strengths helps us to select
modalities and interventions that optimize what she is able to absorb,
digest, and apply in order to transform her ways of thinking, feeling, and
behaving. For example, some approaches are more hands-on, some require
completing homework, some are somatically and sensory based, some are
intellectualized, some involve kinesthetically moving (e.g., psychodrama),
and others incorporate movies. When creating a psychotherapy plan that
synchronizes with his patient’s learning needs, an innovative therapist is
36 Beginnings

limited only by his knowledge of his patient and the modalities available.
The emphasis here is not on style over content. An authentic connection
between patient and therapist, particularly when combined with clear and
intelligent focus, remains the core of positive growth. However, when the
therapist can sensitively speak the same “language” as the patient as well,
then concepts resonate at deeper levels, across sensory channels, and learn-
ing is intensified (see Chapter 23).

CONTOURS AND TOPOGRAPHY, NOT GRIDS

What does a map of our understanding and diagnosis of where the patient
is, where she wants to go, the anticipated terrain along the way, and a route
for our potential journey look like? Conceptually, what we are holding in
mind when we map is a breathing, changing process.
Let’s say we accurately identify a trait in Kelly that seems relevant to
psychotherapy—for example, wariness of being judged. When planning
psychotherapy with Kelly, it is of limited value to simply say that Kelly
feels wary. Any trait in a person is in continual movement. Kelly may be
wary one moment and trusting the next, and all shades in between. There
are activating and mitigating factors inside and outside her that influence
the arrival of her wariness, its intensity, its coloring, and its abatement.
Thus Kelly’s wariness of being judged is not accurately described as simply
existing. In actuality, it shuttles and shimmers through the space between
foreground and background, more and less, depending on what is taking
place—in the moment, in the process, between Kelly and others, between
Kelly and awarenesses of herself, and between Kelly and the shadows of her
past lived experiences.
Although the movement of wariness within Kelly is fluid—because mul-
tiple ingredients are continually affecting its emergence—the patterns of
when wariness shows up in her are neither chaotic nor random. A way
we can capture these patterns of movement is to think about conditions
under which a trait will emerge. For example, we might discern, “When I
am silent, Kelly becomes wary that she is being judged,” or, “When Kelly
hasn’t slept well the night before … ,” or, “When Kelly hasn’t had a lot to
eat … ,” or, “When we begin talking about her mother … .” Similarly, we
might observe, “When my face softens, Kelly is able to rebound into feeling
trusting,” or, “When we can inject humor … ,” or, “When we talk about
her black Lab … ,” and so forth. Conceptualizing traits as simply present
or absent is putting Xs in the boxes of a grid. However, conceptualizing
traits as in movement according to “conditions under which” creates the
contours and topography of a map.
We can capture even more complexity if we appreciate that it is not just
a singular trait that emerges. Instead, a more complex expression develops.
 Mapping 37

This complex expression is a bundling (and often sequencing) of neuro-/

emotional/visceral/behavioral, interactive responses. For example, study
the following description, which would be a worded example of a small
piece of mapping:

When Kelly goes silent and her face reddens, this is sometimes a signal
that something just triggered her wariness about being judged. If noth-
ing is asked or said about her nonverbal reaction, she will become,
overall, less spontaneous in her stories, less animated, and more care-
ful. If one asks simply, “What just happened?” Kelly usually denies
anything has changed and shuts down even more. However, if one
notices gently, with a slow, warm voice, something like, “You got
quiet, and look a little uncomfortable—did I just say something awk-
ward?” then Kelly tends to open up, a little at a time. She seems to need
carefulness, steadiness of warmth, and invitation in order to word her
concerns that something in her is being judged.

What makes this partial narrative more of a map than a piece of linear
case history is its grounding in actual behavior rather than in reported
history, and its creating coherence through following interactive pat-
terns rather than by organizing historical events onto a frame of temporal
sequencing. In addition, the if-then thinking and conditions-under-which
elaborations create a contouring of different interpersonal routes and out-
comes. Also, we see a bit of topography as well—Kelly’s dips into and emer-
gences from tension and closed-offness that are captured by the worded
depiction of Kelly’s delicate movements within the pas de deux between her
and her potential therapist. The nonverbal and verbal expressions between
Kelly and her therapist bundle into pieces of movement back and forth,
becoming a kind of choreography from which, when reflected upon and
worded, a pattern materializes. This is mapping. And from this map, clear
and immediate treatment suggestions are derived.
In beginning, our map tracks the landmarks, contours, and topography
necessary to have in view when outlining an initial therapy route—the
essentials of alliance, focus, vulnerabilities and strengths, and learning
style. We are interested in conceptualizing the best route from here (her
current suffering) to there (where she wishes she could be), by appreciat-
ing what needs to be traversed before new segments of the journey can be
undertaken, where the potential pitfalls are, what resources are available
for recovery and repair, and what vehicle (modalities, interventional styles,
and techniques) is best suited for her learning style, means, internal capaci-
ties, time of life, and goals. Additional detail and regions in the patient’s
personal terrain beyond the essentials are fi lled in as the relationship and
work unfold.
We coconstruct this map with the patient; we build it from observ-
able moments in our initial encounters and the conversations we have
Another random document with
no related content on Scribd:
and is a fine plum for canning and preserving. Its faults are that it is
tardy in coming into bearing and the fruits drop badly from the trees
as they begin to ripen; in localities where these faults are marked
the variety is worthless. Stanton originated as a chance seedling in
Albany County, New York, from whence it was sent to Hammond and
Willard of Geneva, New York, who introduced it about 1885.

Tree very large and vigorous, round-topped, variable in productiveness;

branches slender, marked by transverse cracks in the bark; leaf-scars
enlarged; leaves folded upward, oval or obovate, one and one-half inches
wide, three inches long; margin finely and doubly crenate, with few, dark
glands; petiole short, glandless or with from one to three small glands
usually on the stalk; blooming season intermediate in time and length;
flowers appearing after the leaves, one and one-eighth inches across,
borne in scattering clusters on lateral buds and spurs, singly or in pairs.
Fruit late, season long; about one and one-quarter inches in diameter,
roundish-oblate, truncate, purplish-black, overspread with very heavy
bloom; flesh bright golden-yellow, fibrous, very sweet, rather high-
flavored; good to very good; stone semi-free, three-quarters inch by five-
eighths inch in size, irregular roundish-oval, turgid, with a blunt and
oblique base, the surfaces nearly smooth; ventral suture enlarged, often
with a short, distinct wing; dorsal suture shallow.

STODDARD
Prunus americana

1. Ia. Hort. Soc. Rpt. 78. 1892. 2. Am. Pom. Soc. Rpt. 88. 1895. 3. Am.
Pom. Soc. Cat. 38. 1899. 4. Ia. Sta. Bul. 46:289. 1900. 5. U. S. D. A. Rpt.
478, Pl. LXII. 1902.
Baker 2. Stoddart 1, 2.

Stoddard is usually rated as one of the best of the Americana

plums and its behavior on the grounds of this Station sustains its
reputation. The firmness of the fruit makes it a good shipping plum
of its kind and season. This variety was discovered by B. F. Stoddard
of Jesup, Buchanan County, Iowa, about 1875, growing in a garden
owned by Mrs. Caroline Baker who stated that her husband secured
the trees from the woods, presumably along the Maquoketa River.
The variety was subsequently introduced by J. Wragg and Sons of
Waukee, Iowa, at dates variously reported from 1890 to 1895.

Tree large, vigorous, spreading, open-topped, productive; trunk shaggy;

branches slender, thorny; branchlets slender, with conspicuous, large,
raised lenticels; leaves falling early, flattened, oval or obovate, two and
one-quarter inches wide, four inches long; margin coarsely serrate,
eglandular; petiole tinged red, glandless or with from one to three glands
usually on the stalk; blooming season late; flowers appearing with the
leaves, one inch across, white.
Fruit intermediate in time and length of ripening season; about one and
three-eighths inches in diameter, roundish-oblate; suture a distinct red
line; color light to dark red over a yellow ground, mottled, covered with
thick bloom; skin astringent; flesh dark golden-yellow, very juicy, tender
and melting, rather sweet next the skin but tart near the center, with a
characteristic flavor; good; stone clinging, seven-eighths inch by five-
eighths inch in size, roundish to broad-oval, strongly flattened, with
smooth surfaces; ventral suture narrow, winged.

STONELESS
Prunus insititia

1. Duhamel Trait. Arb. Fr. 2:110, Pl. 20 fig. 14. 1768. 2. Kraft Pom.
Aust. 2:42, Tab. 194 fig. 2. 1796. 3. Mag. Hort. 9:165. 1843. 4. Poiteau
Pom. Franc. 1. 1846. 5. Mas Pom. Gen. 2:121, fig. 61. 1873. 6. Hogg
Fruit Man. 726. 1884. 7. Mathieu Nom. Pom. 450. 1889.
Die Pflaume ohne Stein 2. Jean Morceau 3. Kirke’s Stoneless 6, 7.
Pflaume Ohne Steine 5. Pitless 5, 7. Prune Sans-Noyau 4. Sans-Noyau 1,
5. Sans Noyau 3, 6, 7. Steinlose Zwetsche 7. Stoneless 5, 7.

This curious plum is attracting attention because of the publicity

given it by Burbank in his breeding work. The variety is at least three
hundred years old. It was known to Merlet, writing in the
Seventeenth Century, and has been mentioned in plum literature
many times since. The plum is remarkable because of the entire
absence of a stone, the kernel lying naked in a cavity much larger
than itself. The variety is worthless but presents opportunities for
breeding purposes that should not be overlooked. Judging from the
fruit-characters as given below it belongs to Prunus insititia. The
Stoneless is supposed to have been introduced into England from
the Royal Gardens at Versailles by George London. It was long sold
as Kirke’s Stoneless, having been much advertised by Kirke, a
nurseryman at Brompton, England. It is described as follows:

Fruit small, oval, dark purple, with thick bloom; flesh greenish-yellow,
harsh and strongly acid at first but assuming a more pleasant flavor as it
shrivels upon the tree.

SUGAR
 SUGAR

Prunus domestica

1. Cal. State Bd. Hort. 47. 1897-98. 2. Burbank Cat. 5 fig. 1899. 3.
Waugh Plum Cult. 124. 1901. 4. U. S. D. A. Rpt. 275, Pl. XXXVI fig. 2.
1903.
 Sugar Prune 1, 4.

The introduction of Sugar to the Atlantic States was preceded by

very flattering accounts of it from the originator, Mr. Burbank, and
from Pacific Coast plum-growers. Possibly our expectations were too
high; for we have been greatly disappointed in this plum as
compared with its parent, Agen, as the two varieties grow at Geneva
—it should be said at once that neither grows nearly as well in New
York as in California. The fruits of Sugar on the Station grounds are
not larger than those of the Agen, while in California it is said to be
twice or three times as large; the flavor is not as pleasant and the
flesh is fibrous in the offspring and not so in the parent at Geneva,
though in California the Sugar is said to be of better quality than the
Agen. As the two grow here, Sugar is rather more attractive in
appearance and ripens earlier, the latter character a distinct
advantage since Agen is very late in New York. The trees of the two
plums are much alike though those of Agen are larger and more
productive than those of Sugar as grown in New York. There are,
however, but two trees of the latter variety on the Station grounds
and these are young, set in 1899, so that too much importance must
not be attached to the comparison of the trees. Sugar is worth
further trial in New York under other conditions of soil and climate
but it is extremely doubtful whether it will surpass the Agen in this
State.
This plum, a seedling of the well-known Agen, was introduced by
its originator, Burbank, in 1899. The California Experiment Station in
analyzing this plum found it to be richer in sugar than the Agen and
states that it is larger and more easily dried. Sugar has become of
great commercial importance in the California prune districts and has
been top-grafted on other plums and even on almonds to the extent
of hundreds of acres in that State and in Oregon. As yet it is only
under trial in New York.

Tree of medium size, usually vigorous, spreading, dense-topped, hardy,

productive; branches ash-gray, tinged red, smooth except for the
numerous, small, raised lenticels; branchlets slender, with long internodes,
green changing to brownish-red, dull, sparingly pubescent throughout the
season, with numerous, inconspicuous, small lenticels; leaf-buds large,
long, somewhat pointed, strongly appressed.
Leaves folded backward, obovate or oval, two and one-half inches wide,
five inches long; upper surface dark green, rugose, covered with
numerous hairs, the midrib narrowly grooved; lower surface pale green,
overspread with thick pubescence; apex abruptly pointed or acute, base
acute, margin serrate, with small dark glands; petiole nearly one inch
long, covered with thick pubescence, lightly tinged with red, glandless or
with from one to three small, globose, greenish-yellow glands at the base
of the leaf.
Flowers large, intermediate in time of bloom; calyx-tube green; stamens
longer than the pistil.
Fruit intermediate in time and length of ripening season; small, ovate or
oval, halves equal; cavity shallow, narrow, abrupt; suture shallow, often a
line; apex roundish or pointed; color dark reddish-purple changing to
purplish-black, covered with thick bloom; dots numerous, small, light
russet, inconspicuous; stem slender, long, pubescent, adhering; skin thin,
tender, separating readily; flesh golden-yellow, juicy, coarse, fibrous,
tender, sweet, mild; good to very good; stone light colored, with a tinge of
red, thin, of medium size, ovate, flattened, with rough and pitted surfaces,
blunt at the base, acute at the apex; ventral suture rather narrow,
distinctly furrowed, slightly winged; dorsal suture with a wide, deep
groove.

SURPRISE
 SURPRISE

Prunus hortulana mineri?

1. Wis. Sta. Bul. 63:61 fig. 30. 1897. 2. Ia. Hort. Soc. Rpt. 112. 1899.
3. Am. Pom. Soc. Cat. 38. 1899. 4. Wis. Hort. Soc. Rpt. 69. 1900. 5. Ia.
Sta. Bul. 46:289. 1900. 6. Wis. Sta. Bul. 87:18. 1901. 7. Waugh Plum
 Cult. 175. 1901. 8. Ia. Hort. Soc. Rpt. 228. 1904. 9. Ill. Hort. Soc. Rpt.
426. 1905. 10. S. Dak. Sta. Bul. 93:39. 1905.

Surprise is one of the best of the native plums in the Station

orchard. The fruits are very attractive in appearance and while not of
the rich flavor of the Domesticas they are yet of pleasant flavor with
an abundance of juice which together make this a most refreshing
fruit. The fruits keep well and would probably ship well. The color is
a peculiar red which serves to identify the variety; on the whole the
fruits resemble the Americanas while the trees are rather more of
the Miner type. The variety is productive in New York and is so
spoken of in Wisconsin by Goff,[224] but in Iowa it is said not to bear
abundantly. If a native plum is wanted in New York, this variety is
worthy a trial.
Surprise, according to the originator, Martin Penning of Sleepy
Eye, Brown County, Minnesota, is the best of a thousand or more
seedlings grown from pits of De Soto, Weaver and Miner sown in
1882. In 1889, Penning introduced this plum and ten years later it
was added to the fruit catalog list of the American Pomological
Society. The parentage of the variety is unknown but it has usually
been thought that the botanical characters indicate that it is a
seedling of Miner. As the tree grows here, (they came to the Station
from Mr. Penning,) it appears to be a hybrid of Prunus americana
and Prunus hortulana mineri, characters of both species being
evident.

Tree large, vigorous, upright, dense-topped, hardy, productive; trunk

roughish; branches smooth, zigzag, thorny, dark ash-gray, with numerous,
small lenticels; branchlets slender, medium to long, with long internodes,
green changing to dark chestnut-red, with brownish-gray scarf-skin,
glossy, glabrous, with numerous, conspicuous, small, raised lenticels; leaf-
buds small, short, obtuse, plump, appressed.
Leaves falling early, folded upward, oval or ovate, two inches wide, four
and one-half inches long, thin; upper surface light green, glabrous,
smooth, with a grooved midrib; lower surface pale green, lightly
pubescent; apex taper-pointed, base abrupt, margin often coarsely and
doubly serrate, with amber glands which are not persistent; petiole
thirteen-sixteenths inch long, slender, reddish, sparingly pubescent along
one side, glandless or with from one to five small, globose, yellowish-
brown glands usually on the stalk.
Blooming season intermediate in time and length; flowers appearing
with the leaves, three-quarters inch across, creamy-white, with a
disagreeable odor; borne in clusters from lateral buds, in threes or in
fours; pedicels three-eighths inch long, slender, glabrous, green; calyx-
tube greenish, campanulate, glabrous; calyx-lobes narrow, acute,
pubescent on the inner surface, serrate and with reddish glands, erect;
petals roundish-ovate, entire, narrowly clawed; anthers yellowish;
filaments one-quarter inch long; pistil glabrous, equal to the stamens in
length.
Fruit mid-season, ripening period short; one and three-eighths inches
by one and one-eighth inches in size, halves equal; cavity shallow, flaring;
suture very shallow, distinct; apex roundish or depressed; color dark red,
covered with thin bloom; dots numerous, medium to large, russet,
conspicuous, clustered about the apex; stem one-half inch long, glabrous,
adhering to the fruit; skin thick, tough, clinging; flesh golden-yellow, juicy,
fibrous, somewhat tender, sweet, insipid; quality fair; stone clinging, one
inch by five-eighths inch in size, oval, flattened, pointed at the base and
apex, with smooth surfaces.

TENNANT
 TENNANT

Prunus domestica

1. Bailey Ann. Hort. 133. 1893. 2. Oregon Sta. Bul. 45:32. 1897. 3.
Am. Pom. Soc. Cat. 40. 1899. 4. Can. Exp. Farm Bul. 2nd Ser. 3:57. 1900.
 5. Waugh Plum Cult. 124. 1901. 6. Budd-Hansen Am. Hort. Man. 326.
1903.
Tennant Prune 1. Tenant Prune 4.

It is surprising that a variety of so much merit, especially of so

great beauty, as Tennant, should not have been more widely tried in
New York. In the survey of plum culture in this State in the
preparation of the text for The Plums of New York, it could not be
learned that the Tennant had been tried in more than four or five
places. In size and beauty of form and coloring, all well shown in the
illustration, Tennant has few superiors in the collection of plums
growing at this Station. While it is not sufficiently high in quality to
be called a first-rate dessert fruit it is more palatable than most of
the purple plums. It ripens at a good time of the year, several days
before the Italian Prune, and should, from the nature of its skin and
the firmness of its flesh, both ship and keep well. A fault of the fruit
as it grows here, a fault not ascribed to it elsewhere, is that it
shrivels soon after ripening. Our trees are large, vigorous, healthy,
hardy and productive—almost ideal plum-trees. This variety should
be very generally tried in commercial plantations in New York and
may well be planted in home collections for a culinary fruit at least.
On the Pacific Coast it is cured for prunes, its meaty flesh fitting it
very well for this purpose.
This is another promising plum from the Pacific Northwest.
Tennant originated with Rev. John Tennant of Ferndale, Washington,
and was introduced in 1893 by McGill and McDonald, Salem, Oregon.
The variety is fairly well known in the region of its origin but is
practically unknown in New York. It was listed in the American
Pomological Society catalog in 1897 as successful in the Pacific
Northwest.

Tree large, vigorous, round-topped, open, hardy, productive; trunk

slightly roughened; branches stocky, smooth, with lenticels of medium
number and size; branchlets thick, long, with long internodes, greenish-
red changing to brownish-drab, with green patches and considerable
scarf-skin, somewhat glossy, sparingly pubescent throughout the season,
with small lenticels; leaf-buds large, long, pointed, appressed; leaf-scars
prominent.
Leaves folded backward, oval or obovate, one and three-quarters inches
wide, three and one-half inches long, thick, stiff; upper surface dark
green, rugose, sparingly hairy, with a grooved midrib; lower surface
silvery-green, with thick pubescence; apex abruptly pointed to acute, base
acute, margin crenate, eglandular or with small, brown glands; petiole
five-eighths inch long, thick, tinged red along one side, hairy, glandless or
with one or two rather large, globose, brownish glands variable in
position.
Blooming season early to medium, short; flowers appearing after the
leaves, one inch or more across, white, the buds tinged yellow; borne on
lateral spurs; pedicels one-half inch long, thick, pubescent, greenish;
calyx-tube green, often with a swelling around the base, campanulate,
pubescent; calyx-lobes broad, obtuse, pubescent on both surfaces, with
thick, marginal hairs, erect; petals roundish-oval, entire, tapering to short,
broad claws; anthers large, yellow; filaments five-sixteenths inch long;
pistil pubescent at the base, equal to the stamens in length; stigma large.
Fruit intermediate in time and length of ripening season; one and three-
quarters inches by one and five-eighths inches in size, roundish-truncate
or roundish-oblong, with irregular surface which is somewhat ridged,
halves equal; cavity narrow, abrupt, slightly compressed; suture variable
in depth, distinct; apex deeply depressed; color dark reddish-purple,
overspread with thick bloom; dots numerous, variable in size, whitish,
conspicuous, clustered about the apex; stem thick, three-eighths inch
long, pubescent, adhering well to the fruit; skin tough, adhering slightly to
the pulp; flesh dark golden-yellow, somewhat dry, coarse, tough, firm,
sweet, mild but pleasant; of good quality; stone clinging, seven-eighths
inch by five-eighths inch in size, irregular-oval, flattened, obliquely necked,
blunt at the apex, with deeply pitted surfaces, roughish; ventral suture
prominent, heavily furrowed, not winged; dorsal suture usually with a
narrow, shallow groove.

TRAGEDY
 TRAGEDY

Prunus domestica

1. Cal. State Bd. Hort. 236, Pl. II fig. 5, 237. 1890. 2. Ibid. 109 fig. 8.
1891. 3. Wickson Cal. Fruits 358. 1891. 4. N. Mex. Sta. Bul. 27:125.
1898. 5. Am. Pom. Soc. Cat. 40. 1899. 6. Waugh Plum. Cult. 124. 1901.
 Tragedy Prune 1, 3, 4.

Tragedy is another western plum which, like the Tennant, has not
been well tested in the East. It is an older plum than the Tennant
and somewhat better known in New York but still the reports of it
are not sufficient in number or of great enough range to enable a
fair opinion to be given as to its merits. As the variety grows at
Geneva the fruits are very attractive in appearance—above medium
size, a dark, rich purple color, and having the full, rounded form
much liked by consumers in a dessert plum. The flesh is juicy, tender
and sweet so that the quality may be called good; possibly the flesh
is a little too soft for long shipping or long keeping as it grows here,
though in one of the California references it is spoken of as “valuable
for eastern shipment.” The trees are very satisfactory except that in
New York they are not quite as reliable in bearing as could be
wished. A fault, as the variety grows here and which may be local, is
that a large proportion of the pits are cracked and all are soft and
granular. The tree is reported by some as “scale proof” but
unfortunately this statement can neither be denied nor affirmed. A
plum with the good qualities possessed by Tragedy, should be better
known in New York.
The following history is contributed by Professor E. J. Wickson,
Berkeley, California. Tragedy originated as a chance seedling on the
farm of O. R. Runyon, near Courtland, Sacramento County,
California, probably in the late seventies. It was first offered to the
trade in dormant buds by W. R. Strong and Company of Sacramento
in 1887. Since the German Prune and Duane Purple grew on the
place of its origin and as it shows characters of both, it has been
noted as a probable cross of these varieties. The name Tragedy is
understood to have been given to the fruit by Mr. Runyon because
the plum was noted to be desirable on or about a day upon which a
certain event held to be tragical occurred in the neighborhood. In
1899, the American Pomological Society considered Tragedy worthy
a place in its list of fruits.
 Tree large, vigorous, round-topped, hardy, variable in productiveness;
branches ash-gray, usually smooth, with raised lenticels of various sizes;
branchlets twiggy, thick, medium to short, with short internodes, greenish-
red changing to dark brownish-drab, covered with thick pubescence, with
obscure, small lenticels; leaf-buds intermediate in size and length, obtuse,
plump, appressed.
Leaves folded backward, oval or obovate, one and three-quarters inches
wide, three and three-quarters inches long; upper surface dark green,
glabrous except for the few hairs on the deeply and narrowly grooved
midrib; lower surface pubescent; apex acute or obtuse, base acute;
petiole five-eighths inch long, thick, pubescent, faintly tinged red,
glandless or with one or two small, globose, greenish-brown glands
usually at the base of the leaf.
Blooming season early, short; flowers appearing with the leaves, seven-
eighths inch across, white; borne on lateral buds, usually in pairs; pedicels
one-half inch long, thick, pubescent, greenish; calyx-tube green, with
roughened surface, campanulate, glabrous; calyx-lobes acute, lightly
pubescent, serrate, with many glands and marginal hairs, reflexed; petals
broadly oval, crenate, short-clawed; anthers bright yellow; filaments
nearly five-sixteenths inch long; pistil pubescent at the base, much longer
than the stamens.
Fruit early, season short; one and five-eighths inches by one and three-
eighths inches in size, oval, swollen on the suture side, compressed,
halves unequal; cavity narrow, abrupt, regular; suture shallow, often an
indistinct line; apex roundish; color dark purplish-black, covered with thick
bloom; dots numerous, variable in size, russet, inconspicuous; stem five-
eighths inch long, pubescent, adhering well to the fruit; skin of medium
thickness and toughness, somewhat sour, separating readily; flesh
greenish-yellow, juicy, tender, sweet, mild; good; stone clinging, one inch
by five-eighths inch in size, irregular-oval, flattened, obliquely necked;
apex acute; surfaces pitted, roughish; ventral suture narrow, prominent,
not winged; dorsal suture narrowly and deeply grooved.

TRANSPARENT
Prunus domestica

1. Downing Fr. Trees Am. 395. 1857. 2. Flor. & Pom. 56, Col. Pl. fig.
1862. 3. Hogg Fruit Man. 383. 1866. 4. Downing Fr. Trees Am. 950. 1869.
5. Jour. Hort. N. S. 17:258. 1869. 6. Am. Pom. Soc. Rpt. 91. 1869. 7. Am.
 Pom. Soc. Cat. 24. 1871. 8. Pom. France 7: No. 25. 1871. 9. Mas Pom.
Gen. 2:31, fig. 16. 1873. 10. Cat. Cong. Pom. France 365. 1887. 11.
Mathieu Nom. Pom. 428. 1889. 12. Guide Prat. 154, 364. 1895. 13.
Nicholson Dict. Gard. 3:166. 14. Waugh Plum Cult. 124. 1901. 15. Soc.
Nat. Hort. France Pom. 554 fig. 1904.
Diaphane 4, 12. Diaphane Lafay 4. Durchscheinende Reineclaude 9, 12.
Durchscheinende Reine-Claude 11. Prune Diaphane 9. Prune Diaphane
Laffay 4, 11. Reine-Claude De Guigne 9. Reine-Claude Diaphane 1, 8, 9,
10, 12, 15. Reine-Claude Diaphane 2, 3, 4, 5, 11. Reine-Claude
Transparente 9, 11, 12, 15. Reine-Claude Transparent 4. Transparent
Green Gage 6. Transparent Gage 3, 4, 7, 8, 13. Transparent Gage 8, 9, 10,
11, 12, 14, 15. Transparent Gage Plum 2, 5.

In Europe Transparent is considered one of the best of all dessert

plums but either it does not do as well in America or the American
bred plums of the Reine Claude group, to which this variety belongs,
are much better on this continent than in the Old World. At any rate
in our soil and climate there are a dozen or more Reine Claude
plums as good or better in quality than Transparent and much
superior in other characters. It is, however, worth planting by the
connoisseur for its quality and because of the transparency of skin—
in the latter respect it is unique among Domestica plums. The
flower-buds of this variety have a remarkable tendency to produce
leaves in the place of floral organs.
Transparent is an old French variety. M. Lafay, a rose-grower at
Bellevue, near Paris, raised it from the seed of the Reine Claude and
named it Reine Claude Diaphane. It was grown previous to 1836, for,
during this year, Thomas Rivers of England, while visiting M. Lafay,
was told of its origin. In 1871, the American Pomological Society
listed Transparent in its catalog as worthy of culture. The color of
this variety leads to the suspicion that Reine Claude is not the only
parent.

Tree large, vigorous, spreading, open-topped, hardy, productive;

branches slender, ash-gray, roughish towards the trunk, with small
lenticels; branchlets above medium in thickness, short, with internodes of
average length, green changing to brownish-red often retaining some
green, dull, pubescent, with small lenticels; leaf-buds of medium size and
length, conical, somewhat appressed.
Leaves folded upward, obovate or oval, two and one-half inches wide,
five inches long, above average thickness; upper surface rugose, nearly
glabrous, with a grooved midrib; lower surface pubescent; apex abruptly
pointed or acute, base acute, margin often doubly serrate or crenate, with
small, dark glands; petiole seven-eighths inch long, thick, pubescent,
faintly tinged red, glandless or with from one to four rather large, globose
or oval, greenish-brown glands usually on the stalk.
Season of bloom medium, short; flowers appearing after the leaves, one
and one-eighth inches across, white; borne in scattering clusters on lateral
buds and spurs, singly or in pairs; pedicels five-eighths inch long, thick,
pubescent, greenish; calyx-tube green, campanulate, glabrous; calyx-
lobes obtuse, lightly pubescent, glandular-serrate, reflexed; petals
obovate, crenate, tapering to short, broad claws; anthers yellow with a
tinge of red; filaments three-eighths inch long; pistil glabrous, shorter
than the stamens, often in pairs.
Fruit late, intermediate in length of ripening season; one and three-
eighths inches by one and one-half inches in size, oblate, compressed;
halves equal; cavity wide, flaring; suture a line; apex flattened or
depressed; color red over a dark amber-yellow ground, mottled, covered
with thin bloom; dots numerous, grayish or light russet, conspicuous,
decreasing in number but increasing in size towards the cavity; stem thick,
three-quarters inch long, pubescent, adhering well to the fruit; skin thin,
adhering but slightly; flesh golden-yellow, juicy, fibrous, tender, very
sweet, aromatic, pleasant; very good to best; stone clinging, five-eighths
inch by one-half inch in size, roundish-oval, turgid, blunt at the base and
apex, with slightly pitted surfaces; ventral suture, wide, blunt, faintly
grooved; dorsal suture with a deep groove of medium width.

UNGARISH
Prunus domestica

1. Ia. Agr. Col. Bul. 50, 51. 1886. 2. Ia. Hort. Soc. Rpt. 86. 1890. 3.
Mich. Sta. Bul. 118:53. 1895. 4. Kan. Sta. Bul. 101:117, 119, 120 fig.
1901. 5. Waugh Plum Cult. 109. 1901. 6. Can. Exp. Farms Rpt. 102. 1902.
7. Budd-Hansen Am. Hort. Man. 326. 1903. 8. Can. Exp. Farms Rpt. 433.
1905.
 Hungarian 3, ?6. Hungarian Prune 3. Hungarian Prune 4. Hungary 1.
Ungarische 8. Ungarish Prune 2, 7. Quetsche de Hongrie 1. Zwetsche
Ungarische 1.

Budd’s Ungarish as grown at the New York State Experiment

Station is nearly identical with the Italian Prune. The only differences
to be detected are that the Italian Prune is a trifle smaller, a little
more firm, not as broad and not quite as sweet as the Ungarish. The
pit of the latter is usually tinged with red, while that of the former is
rarely so colored. If the Ungarish prove as productive as the Italian
Prune it may be more desirable because of its larger size. In 1883
Professor J. L. Budd of the Iowa Experiment Station imported trees
under the name Quetsche de Hongrie or Zwetsche Ungarische from
C. H. Wagner of Riga, Russia and from Wilhelm Wohler of Wilna,
Russia. Budd disseminated the variety as Hungary, a name soon
changed to Hungarian Prune and later to Ungarish. This is not to be
confused with the true Hungarian so well known in Europe as the
Quetsche de Hongrie.

UTAH
Prunus besseyi × Prunus watsoni

1. Dieck in Dippel Laubholzkunde 3:634. 1893. 2. Cornell Sta. Bul.

70:262, Pl. II fig. 3. 1894. 3. Tex. Sta. Bul. 32:490. 1894. 4. Vt. Sta. Bul.
67:21. 1898. 5. Waugh Plum Cult. 225. 1901.
Black Utah Hybrid 2, 4, 5. Utah Hybrid 1, 2, 3, 4, 5.

This interesting natural hybrid was grown by J. E. Johnson at

Wood River, Nebraska, some time previous to 1870. Mr. Johnson
planted seed of the native dwarf cherry which had grown near Sand
plums and which supposedly had been pollinized by the plums. The
resulting plants proved to be intermediates between the cherry and
the plum and are now generally thought to be natural hybrids. From
these seedlings, one was selected and propagated. Shortly
afterwards Mr. Johnson moved to Utah taking his new hybrid with
him and from there distributed it as Utah. In 1893 a German
botanist, Dieck (References, 1), described this hybrid and gave it the
specific name Prunus utahensis. The plant has no commercial value.
It is described as follows:

Tree a dwarfish tree-like bush three or four feet in height; branches and
branchlets zigzag after the habit of Prunus watsoni: leaves small, narrow-
ovate, pointed at the ends; margins crenulate, glandless, sometimes small
glands on the petioles; fruit early, small, round, dark mahogany-red,
covered with bloom; skin very bitter; flesh melting; pleasant flavor; quality
poor; stone small, round like that of a cherry.

VICTORIA
 VICTORIA

Prunus domestica

1. Lond. Hort. Soc. Cat. 153. 1831. 2. Downing Fr. Trees Am. 315.
1845. 3. Ann. Pom. Belge 45, Pl. 1856. 4. Thompson Gard. Ass’t 516.
1859. 5. Cultivator 8:26 fig. 1860. 6. Am. Pom. Soc. Cat. 88. 1862. 7.
 Thomas Am. Fruit Cult. 349 fig. 379. 1867. 8. Downing Fr. Trees Am. 948.
1869. 9. Pom. France 7: No. 13. 1871. 10. Mas Le Verger 6:23, fig. 12.
1866-73. 11. Oberdieck Deut. Obst. Sort. 419. 1881. 12. Hogg Fruit Man.
728. 1884. 13. Mathieu Nom. Pom. 438. 1889. 14. Gaucher Pom. Prak.
Obst. No. 98 fig. 1894. 15. Guide Prat. 159, 367. 1895. 16. Cornell Sta.
Bul. 131:193. 1897. 17. Jour. Roy. Hort. Soc. 21:222. 1897. 18. Mich.
Sta. Bul. 169:243, 248. 1899. 19. Garden 57:267. 1900. 20. Waugh Plum
Cult. 122, 123 fig. 1901.
Alderton 4, 6, 8, 9, 12, 13, 14, 15. Dauphin 8, 13. Denyer’s Victoria ?2,
3, 6, 8, 9, 12, 13, 14, 15. Denyer’s Victoria 4. Dolphin 8, 13. Imperial de
Sharp 8, 13. Königin Victoria 11, 13, 15. Königin Victoria 9, 14, 15. La
Victorine 1. Prune Reine Victoria 3. Queen Victoria ?2, 3, 13, 14, 15.
Queen Victoria 9. Reine Victoria 9, 10, 13, 14, of some 15. Royal Dauphine
8, 13. Sharp 20. Sharp’s Emperor 2, 8. Sharp’s Emperor 3, 9, 10, 12, 13,
by error 15, 20. Sharpe’s Emperor, 17 incor. Victoria-Pflaume 14. Sharp’s
Kaiserpflaume 13. Victoria 8, 9, 13, 14, 20. Victoria’s Kaiserzwetsche 14,
15.

For some reason Victoria, long known in America, has never

attained great popularity in this country. It is a large plum attaining
nearly the size of Pond, though the color-plate does not so show it,
and has much the same color as the plum with which we have just
compared it. Here resemblances cease for Victoria is not the same
shape as Pond, is a little better in quality, is earlier and quite
different in tree-characters. It would seem that this would make a
good market plum as it is firm enough in flesh to ship well, as grown
here keeps remarkably well, is better in quality than the average
market plum and is handsome, though Americans seem to care little
for red plums, preferring the yellow sorts and still more the purple
kinds. Unfortunately, Victoria does not always color well in our
climate. The trees of this variety at this Station, while productive, are
not large nor robust, and the foliage is a little too susceptible to
fungi. These defects of the tree may account for the lack of
popularity of the variety in New York though even if they are to be
found in all localities, which is probably not the case, this plum is still
worth growing to some extent for home or market.
The origin of this plum and even its right to the name under which
it is discussed here are matters of controversy. The London
Horticultural Society in 1831 mentioned La Victorine in its catalog
but since no description was given it cannot be identified as Victoria.
Sharp’s Emperor which has been confused with this variety, was
described in the same publication. These two varieties were
considered as identical by Charles Downing, Hogg, Mas and others;
while Royer[225] who tested Sharp’s Emperor, obtained from Liegel,
thought it to be distinct, as did Thomas, the Guide Pratique and
Pearson of England. Hogg in describing the Victoria says, “This is a
Sussex plum, and was discovered in a garden at Alderton in that
county. It became known as Sharp’s Emperor, and was ultimately
sold by a nurseryman named Denyer, in the year 1844 at Brixton,
near London, at a high price as a new variety under the name of
Denyer’s Victoria.” Pearson in the Journal of the Royal Horticultural
Society for 1897 says the reason that Hogg and other authorities
had called these varieties identical is that they had not seen the true
variety. At this Station we have not seen Sharp’s Emperor but
judging from the descriptions it is distinct though very similar. The
American Pomological Society placed Victoria on its fruit list in 1862
but in 1871, Sharp’s Emperor was substituted as the correct name
with Victoria as a synonym. This change was probably made to
comply with Downing’s nomenclature of 1869. A review of the whole
controversy cannot but lead to the conclusion that Victoria is the
correct name and it appears also to be in most common use.

Tree of medium size and vigor, upright-spreading, hardy, productive;

branches ash-gray, smooth, with few large lenticels; branchlets thick,
short, stout, with short internodes, greenish changing to dark brownish-
drab, dull, with thick pubescence, with few inconspicuous, small lenticels;
leaf-buds large, long, conical or pointed, free.
Leaves folded backward, obovate, two and three-eighths inches wide,
five inches long, thick, stiff; upper surface dark green, rugose, with a
narrow groove on the midrib, sparingly hairy; lower surface medium
green, thickly pubescent; apex abruptly pointed, base cuneate, margin
serrate or crenate, eglandular or with small dark glands; petiole one inch
long, covered with thick pubescence, tinged red on one side, glandless or
with from one to three globose or reniform, yellow glands usually on the
stalk.
 Season of bloom medium, short; flowers appearing with the leaves, one
and one-eighth inches across, white, the buds tinged yellow; borne in
clusters on lateral buds and spurs, singly or in pairs; pedicels nearly three-
eighths inch long, thick, heavily pubescent; calyx-tube green,
campanulate, pubescent; calyx-lobes medium to narrow, obtuse,
glandular-serrate, thickly pubescent on both surfaces, reflexed; petals
roundish-obovate, entire or occasionally notched, tapering to short, broad
claws; anthers yellow; filaments one-quarter inch long; pistil glabrous,
longer than the stamens.
Fruit mid-season, ripening period of medium length; one and seven-
eighths inches by one and one-half inches in size, long-oval, oblong,
compressed, halves equal; cavity shallow, narrow, flaring; suture variable
in depth, prominent; apex roundish or depressed; color dark red, mottled
before full maturity, covered with thick bloom; dots numerous, russet,
conspicuous; stem thick, three-quarters inch long, very pubescent,
adhering strongly to the fruit; skin thin, tender, adhering but slightly; flesh
light yellow, juicy, coarse, firm, sweet, mild but pleasant; good; stone
free, one and one-eighth inches by three-eighths inch in size, broad-oval,
strongly flattened, deeply pitted, roughish, blunt at the base and apex;
ventral suture narrow, distinctly winged; dorsal suture widely and deeply
grooved.

VIOLET DIAPER
Prunus domestica

1. Parkinson Par. Ter. 576, 578. 1629. 2. Langley Pomona 93, Pl. XXIII
fig. II. 1729. 3. Duhamel Trait. Arb. Fr. 2:101, Pl. XVII fig. 1768. 4. Prince
Pom. Man. 2:70, 92. 1832. 5. Elliott Fr. Book 425. 1854. 6. Koch Deut.
Obst. 572. 1876. 7. Le Bon Jard. 339. 1882. 8. Hogg Fruit Man. 690.
1884. 9. Mathieu Nom. Pom. 452. 1889. 10. Guide Prat. 157, 355. 1895.
Black Diapred 1. Blaue Diaprée 9, 10. Blaue Herzformige Pflaume 9, 10.
Buntfarbige Violette Pflaume 9, 10. Cheston 1, 9, 10. Cheston 4, 5, 8.
Cheston Matchless 5. Cheston’s Plumb 2. Dennie 1. Diaprée noire 7. Die
Violette Diaprée 10. Diaprée Violette 3, 10. Diaprée Violette 4, 8, 9. Diapre
Violet 4. Friars 1. Friars 8. Friar’s Plum 9. Matchless 4, 5, 9, 10. Purple
Diaper 6. Violet Diaper 5, 9. Violette Diaprée 9. Violette Violen Pflaume 9,
10. Veilchen Pflaume 9, 10.
 Violet Diaper was cultivated at the beginning of the Seventeenth
Century and has maintained itself in Europe until the present time
although never attaining nor deserving the popularity of the Red
Diaper. Matchless, cited as a synonym, is manifestly incorrect as the
true Matchless is a yellow plum; but since it has been used so long
and by so many writers as a synonym, it seems best to mention it as
such. This plum is not grown in America. It is described as follows:

Fruit early; of medium size, oval; suture faint; cavity almost lacking;
skin free; dark purple, covered with thick bloom; flesh yellow, firm, sweet;
good; freestone.

VORONESH
 VORONESH

Prunus domestica

1. Am. Pom. Soc. Rpt. 76. 1883. 2. Ibid. 61. 1887. 3. Am. Gard. 11:625
fig. 1. 1890. 4. Waugh Plum Cult. 116. 1901. 5. Budd-Hansen Am. Hort.
Man. 327, 329. 1903.
 Moldavka 1, 2, 3, 4. Voronesh Yellow 3, 5. Yellow Moldavka 5. Yellow
Voronesh 2.

Voronesh is a Russian sort supposed to be ironclad as to cold. It is

perfectly hardy at Geneva, the trees are also very productive and the
fruits are attractive enough in size and color to meet market
demands but the flavor is so insipid as to make the plum unfit for
dessert and hardly fit for kitchen use. It is given the honor of a
color-plate because it is a somewhat distinct type. In 1881 Professor
J. L. Budd secured from J. E. Fisher, Voronesh, Russia, a variety
which he introduced as Voronesh Yellow. At the same time he
imported a variety from Fisher under the name Moldavka which
proved to be identical with his Voronesh Yellow, though Budd held
that while they were very similar the Moldavka was more oval than
Voronesh.

Tree of medium size, round-topped, productive; leaves drooping, folded

backward, narrow-obovate, two and one-quarter inches wide, four and
one-half inches long, thick; margin doubly serrate, with small, yellowish
glands; petiole one-half inch long, tinged red, pubescent, sometimes with
two globose, yellowish-red glands usually on the stalk near the base of
the leaf; blooming season early, short; flowers appearing after the leaves,
fully one and one-eighth inches across, dull white; borne on lateral buds
and spurs, singly or in pairs.
Fruit mid-season, ripening period short; one and seven-eighths inches
by one and one-half inches in size, ovate, necked, slightly enlarged on the
suture side, dark lemon-yellow, with thin bloom; dots very numerous, of
medium size, white, conspicuous; stem adhering strongly to the fruit; skin
tough, sour; flesh dark amber-yellow, very tender, sweet, mild; poor;
stone free, one and three-eighths inches by five-eighths inch in size, long-
oval, flattened, somewhat necked, acute at the apex, the surfaces smooth
or partially honeycombed; ventral suture prominent.

WALES
Prunus domestica
 1. Gard. Chron. 5:837. 1845. 2. Mag. Hort. 12:340. 1846. 3. McIntosh
Bk. Gard. 529. 1855. 4. Downing Fr. Trees Am. 392. 1857. 5. Thompson
Gard. Ass’t 515. 1859. 6. Ann. Pom. Belge 7, Pl. 1859. 7. Mas Pom. Gen.
2:119, fig. 60. 1873. 8. Flor. & Pom. 253, Pl. 1875. 9. W. N. Y. Hort. Soc.
Rpt. 21:20. 1876. 10. Hogg Fruit Man. 718. 1884. 11. Mathieu Nom.
Pom. 443. 1889. 12. Ont. Fr. Exp. Sta. Rpt. 96, 120. 1896. 13. Cornell
Sta. Bul. 131:190. 1897. 14. Am. Pom. Soc. Cat. 26. 1897. 15. Ohio Sta.
Bul. 113:160. 1899. 16. Waugh Plum Cult. 125. 1901.
Chapman’s Prince of Wales, 3, 5. Chapman’s Prince of Wales 4, 10, 11.
Chapman’s Prince of Wales’ Plum 1. Prince Albert? 11. Prince De Galles 7.
Prince De Galles 6, 11. Prince of Wales 2, 4, 8, 9, 10, 12, 13, 15. Prince of
Wales 7, 11, 14, 16. Prinz Von Wales 11. Prune Prince of Whales 6.

Wales, more commonly known as the Prince of Wales, seems to

have much merit yet it has long been grown in America, probably
three-quarters of a century, without attaining distinction with fruit-
growers. In recent years it has been favorably commented upon in a
number of publications and seems to be better known and more
grown than formerly. Whether this tardily-given recognition is not
too late is a question. So many good plums have been introduced
both at home and abroad in the last few decades that a sort dating
back nearly a century must be meritorious, indeed, to stand the
competition. As Wales grows in New York, it is rather too poor in
quality to recommend it for a home variety and the plums are too
small, as they generally grow, for a good commercial fruit. The trees
are enormously productive and are very satisfactory in other
characters as well. In a bulletin from the Cornell Station (References,
13) this variety is said to have “much to commend it for general
favor:” while in Ohio (References, 15) it is thought that Wales “ought
to become popular.”
Wales, a seedling of Orleans, was raised by a Mr. Chapman,
Brentford, Middlesex, England, in 1830. It was exhibited before the
London Horticultural Society in 1845 where it was awarded a prize.
The following year, Hovey, the American pomologist, (References, 2)
described the variety but the date of the first importation to this
country is unknown. It was not until 1897 that the variety was
sufficiently known to be placed on the fruit catalog list of the
American Pomological Society.

Tree large, vigorous, slightly vasiform, open-topped, hardy, very

productive; branches ash-gray, smooth except for the numerous, small,
slightly raised lenticels, often marked by concentric rings; branchlets of
medium thickness and length, with long internodes, green changing to
brownish-red, dull, thinly pubescent, with numerous, inconspicuous, small
lenticels; leaf-buds large, long, conical or pointed; leaf-scars prominent.
Leaves folded upward, roundish-ovate or oval, two and one-half inches
wide, three and one-half inches long; upper surface dark green,
somewhat rugose, covered with numerous hairs; lower surface pale
green, thickly pubescent; apex and base abrupt, margin crenate,
eglandular or with small dark glands; petiole one-half inch long,
pubescent, tinged red, glandless or with from one to three small, globose,
yellowish-brown glands usually at the base of the leaf.
Blooming season short; flowers one inch across, white, with a yellow
tinge; usually borne in pairs; pedicels eleven-sixteenths inch long, thick,
pubescent, greenish; calyx-tube green, campanulate, lightly pubescent
toward the base; calyx-lobes broad, obtuse, pubescent on both surfaces,
glandular-serrate and with marginal hairs, erect; petals broadly oval,
crenate, tapering to short, blunt claws; filaments five-sixteenths inch long;
pistil glabrous except on the ovary, longer than the stamens; stigma large.
Fruit late, season short; one and five-eighths inches by one and one-
half inches in size, roundish-oval, halves equal; cavity narrow, abrupt;
suture a line; apex roundish; color reddish-purple, overspread with thick
bloom; dots few, large, often tinged red, conspicuous; stem thick, one-
half inch long, pubescent, adhering well to the fruit; skin tough,
separating readily; flesh golden-yellow, juicy, tender, sweet, mild; good;
stone semi-free or free, seven-eighths inch by five-eighths inch in size,
oval, turgid, blunt at the base and apex, with slightly pitted surfaces;
ventral suture narrow, often acute or with a slight wing; dorsal suture
widely and deeply grooved.

WANGENHEIM
Prunus domestica
 1. Cultivator 8:26 fig. 1860. 2. Mas Le Verger 6:157, fig. 79. 1866-73.
3. Am. Pom. Soc. Cat. XXIV. 1871. 4. Mathieu Nom. Pom. 453. 1889. 5.
Guide Prat. 159, 367. 1895. 6. Waugh Plum Cult. 125. 1901.
Die Wangenheim 4. De Wangenheim 5. Prune de Wangenheim 4. Prune
Wangenheim Hâtive 4. Quetsche Précoce de Wangenheim 2, 4, 5. Von
Wangenheim Pflaume 2, 4, 5. Wangenheims Frühzwetsche 2, 5.
Wangenheims Früh Zwetsche 4. Wangenheim Hâtive 4.

This variety, very well known and highly esteemed in Germany,

has been grown to some extent in America both on the Pacific and
Atlantic Coasts and in neither region has it proved equal to standard
plums. According to Dittrich, Wangenheim originated at Beinheim, a
small place near Gotha, Saxe-Cobourg, Germany.

Tree large, vigorous, upright-spreading, productive; trunk rough;

branches rough, stocky; branchlets nearly glabrous; leaves folded upward,
slightly rugose; margin finely serrate, with small glands; petiole tinged
red, pubescent, with from one to three small glands usually at the base of
the leaf.
Fruit mid-season; one and one-quarter inches by one and one-eighth
inches in size, ovate, purplish-red, covered with thin bloom, yellowish,
rather dry, firm, sweet, mild; of good quality; stone very free, three-
quarters inch by one-half inch in size, irregular-oval, flattened, with faintly
pitted surfaces; ventral suture distinctly winged; dorsal suture with a
narrow, shallow groove.

WASHINGTON
 WASHINGTON

Prunus domestica

1. Prince Treat. Hort. 24. 1828. 2. Pom. Mag. 1:16, Pl. 1828. 3. Lond.
Hort. Soc. Cat. 154. 1831. 4. Prince Pom. Man. 2:53. 1832. 5. Floy-
Lindley Guide Orch. Gard. 298, 383, 418. 1846. 6. Cole Am. Fr. Book 210.