I rarely give much thought to a patient’s plan, and yet I believe that s/he has one. I find it difficult to imagine someone coming to me for help and simply sitting there repeating/enacting their pathogenic beliefs (in the interest of safety) and not, at the same time, have a powerful wish for the therapist to somehow provide a way out. After all, the patient isn’t coming to a barber (I should talk) but a therapist. Further,why would we want to assume that there is only some vague and general wish to feel better and not accord that wish any further intelligence? In my own research on sexuality, I have found that there is an enormously complex unconscious process underlying a simple moment of sexual arousal---scenarios are created, role-relationships are established, etc--all with the unconscious intention of bypassing or disconfirming specific pathogenic beliefs. If that’s the case, why begrudge a patient’s attempts at self-cure at least the same degree of creative agency and “planfulness?”

On the other hand, I rarely think about plans per se. I don’t ever make a “plan formulation. I would be interested in hearing from people about how specific or formal their own assessment of patients’ “plans” actually are. I mainly try to figure out and disconfirm pathogenic beliefs. And I usually know a test when I see one. But plans? It was historically useful in staking out the fact that we believe in unconscious thinking and decision making, and, so, theoretically, it makes sense. And it was and is useful in positioning us within the broad humanist tradition of seeing people as striving to get better and transcend their limitations. But how does it inform our work exactly? I don’t’ think I use it to figure out whether something is a test or how to pass it. How ‘bout others?

I realize, however, that I do think along the lines of “he’s working on trying to feel more independent and entitled” and so, in that case, I suppose that I’m implying a plan. And sometimes I find it useful in providing a rationale for the fact that people don’t work on everything at once and that there are many instances where, for example, a patient has to overcome his/her guilt about being strong and assertive before feeling safe and strong enough to tackle feelings of rejection.

So, I suppose in general it seems to me that the concept of an unconscious plan is usually a sensible “taken-for-granted” starting place or background assumption of my work but one that I rarely put any conscious thought into.