Control-mastery Theory Research Articles

Chronic couple conflictuality according to control-mastery theory.

Chronic couple conflictuality according to control-mastery theory.

Notes on some non-psychotic hypochondriacal states

The aim of this paper is to propose a psychodynamic hypothesis based on control-mastery theory (CMT) about the self-punishment function of some non-psychotic hypochondriacal states. After a review of several major psychoanalytic hypotheses about hypochondria, we will show the main concepts of CMT, an integrative, relational, cognitive-dynamic theory of mental functioning, psychopathology, and therapeutic process that is the theoretical framework that has helped us understand and treat these states in our patients. We will then describe two clinical cases to show how some hypochondriacal states can be interpreted as self-punishments connected to three main kinds of guilt hypothesized by CMT: survivor guilt, burdening guilt, and separation/disloyalty guilt. Finally, we will discuss the implications of these hypotheses.

Effect of Interactive Media-Based Music and Art Therapies on Reduction in PTSD Symptoms in Children and Adult Victims of Abduction

The aim of this study was to examine the impact of music and art therapies in reducing symptoms of PTSD among children and adults with abduction experiences in Nigeria. The study was a quasi-experiment with a pre-test, post-test and follow-up assessment design. The participants were divided into control (n = 107), music therapy (n = 108) and art therapy (n = 108) groups. The result of the ANCOVA analysis revealed no significant interactive effect of family happiness on the relationship between the interventions and reduction in PTSD symptoms, F(1,295)0.037 p = 0.848). However, there was a significant main effect of the treatment condition and PTSD scores of the participants at Times 1, 2, and 3, respectively F(1,295). 1640.756, p = 0.001). The degree of the relationship was assessed using partial eta squared, which yielded (ηp 2= 0.848). It was also found that music therapy was more effective in reducing PTSD symptoms in children, while art therapy was more effective in reducing PTSD in adults. The result of this study could be useful for psychologists and mental health experts who may be interested in designing and implementing interventions targeting children and adults with PTSD symptoms. The result also has implications for control mastery theory by showing that music and art therapies could be useful in helping adults and children gain control of their minds after exposure to traumatic events.

Passing patients’ tests and following patients’ coaching communications in psychotherapy: an empirical study

ABSTRACT According to Control-Mastery Theory, patients attend therapy with an unconscious plan to achieve adaptive goals and disprove their pathogenic beliefs. One important way patients work to disconfirm these beliefs is by testing them. Moreover, patients coach their therapists on what they need at different times during their treatment. The aim of this study is to expand the results of previous studies suggesting that therapists’ responses that support patients’ plan predict progress. We investigated whether therapists' ability to pass patients’ tests correlated with patients' improvement in the following session and whether their ability to follow patients' coaches correlated with immediate improvement. Transcriptions of 98 sessions from six brief psychodynamic psychotherapies were assessed by 12 independent raters. The patients’ plans were formulated, and tests and coaching communications were identified. The accuracy of the therapist’s responses to these tests and coaches was rated, and the impact of the therapist’s interventions on the patient’s following communication was measured. The results showed that when a therapist’s intervention passes a patient's tests, patients show signs of improvement both immediately and in the following session, and when therapists follow patients’ coaches, patients show signs of immediate improvement. The clinical implications and limitations of the findings are discussed.

Features of Pathogenic Beliefs in the Context of Childhood Maltreatment: Implications for Therapeutic Empathy

ABSTRACT One reason why patients may seek therapy is to address constricting beliefs about themselves, others and the world that diminish the quality of their lives. These pathogenic beliefs interfere with the pursuit of personal goals and are often the source of considerable distress. In this paper, we discuss the perspective from Control-Mastery Theory that such beliefs were once adaptive in the context of earlier traumatic relational experience, and are often held in place by loyalties and attachment ties to important figures. Therapists can facilitate patients’ efforts to disconfirm these beliefs by empathically understanding the form and function of the patient’s pathogenic beliefs historically and in the present. Such understanding is termed “person empathy” and is found to contribute to positive therapeutic outcomes. With the aim of helping to facilitate therapists’ empathy regarding patients’ pathogenic beliefs, we describe in this paper some of the original functions and subsequent consequences of such beliefs in patients’ lives.

Kontrol Ustalığı Teorisi

The subject of this article is to provide information about Control Mastery Theory (CMT) and to review the therapeutic relationship between therapist and patient from the perspective of CMT. CMT offers a useful, transtheoretical approach that provides case formulation for each patient, empirically tested for over forty years. This theory is a theory of psychopathology and psychotherapy that offers insight into the origins of psychopathology and how patients work in psychotherapy to overcome their problems. At the same time, CMT opens horizons that enable progress on the path of becoming a therapist. The main concepts of KUT including the patient's pathogenic beliefs, his unconscious plan, and the patient's testing methods and the therapist's responsiveness to these tests, are the main topics of this article. Key Words: Control Mastery Theory, Plan Formulation Method

Assessing Burdening Guilt and Its Correlates.

Burdening guilt refers to the belief that one's emotions, needs, and ways of being are a burden to others, and is one type of interpersonal guilt proposed by the control-mastery theory (CMT). The aim of this article is to validate two new measures of burdening guilt. In the two studies conducted, we examined the psychometric properties of these scales and the relationship between burdening guilt and self-perceived burden (burdensomeness), self-esteem, shame, anxiety, depression, mental health, attachment insecurity, adverse childhood experiences, social desirability, empathy, and suicidal ideation. In Study 1, we presented a newly developed Burdening Guilt Rating Scale (BGRS) and its correlation with measures of the abovementioned dimensions. In Study 2 we verified, through confirmatory factor analysis and correlation techniques, the possibility of expanding the Interpersonal Guilt Rating Scale-15 with a shorter, 5-item burdening guilt scale derived from the BGRS, and showed that this shorter scale correlates similarly to the longer one. Findings allowed us to validate these new scales providing empirical measures of burdening guilt-a theoretical concept with important clinical implications.

Testing and treatment-by-attitude in psychotherapy for pathological narcissism: A clinical illustration.

Pathological narcissism is a personality constellation comprising distorted self-image, maladaptive self-esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control-mastery theory(CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time-limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism.

Vicious Relational Circles and Chronic Couple Conflictuality: An Empirical Study

The study aims to empirically assess the control-mastery theory hypothesis that considers chronic couple conflictuality as the repetition of relational vicious circles—that is, interactions where both partners test their pathogenic beliefs and fail their reciprocal tests, confirming their reciprocal pathogenic beliefs. In addition, the study aims to verify if interpersonal guilt is more activated during couple conflicts. Our study involved 11 couples treated by four experienced therapists and nine trained, independent judges who, after reading verbatim transcripts of the couples’ psychotherapy sessions, used the Patient Scale of Couple Testing (PSCT), and the Patient Interpersonal Guilt Rating Scale (PIGRS) to rate segments of couple sessions. The results were obtained by applying generalized estimating equations and confirm our hypotheses: we could observe a greater presence of testing activity and confirmation of pathogenic beliefs in segments classified as conflictual for both partners and a stronger presence of interpersonal guilt in conflictual versus nonconflictual interactions. These findings support the idea that conflict interactions can be seen as failed attempts by both partners to disconfirm their pathogenic beliefs.

Burdening guilt: Theoretical and clinical features

The aim of this paper is to explore the theoretical and clinical features of burdening guilt according to control-mastery theory (CMT), an integrative, relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapy. CMT posits that burdening guilt stems from the belief that one’s emotions, needs, and way of being are a burden to significant others. After having introduced some research data about the belief of being a burden to others, we will point out how CMT explains this belief in light of a coherent theory of development, emphasizing its connection with early traumatic or adverse experiences with caregivers that give rise to the formation of pathogenic beliefs. These beliefs are mostly unconscious, and influence the way people make sense of themselves and their reality, giving rise to symptoms, inhibitions, and maladaptive personality traits that obstruct the achievement of healthy and adaptive goals. We will then compare burdening guilt with omnipotent responsibility guilt and self-hate, highlighting the points of contact and the differences between these types of interpersonal guilt. Subsequently, we will point out the “double nature” of burdening guilt, describing how it represents both a self-blame for what one is, and the expression of the need to take care of important others. Finally, we will propose a clinical vignette to illustrate some manifestations of burdening guilt in the therapeutic context.

Safety in control-mastery theory

This study presents an overview of the development of the main psychoanalytic conceptions regarding safety, an aspect that has received increasing attention within the psychoanalytic literature. After describing the hypotheses of Sigmund Freud, Joseph Sandler, John Bowlby, and Harry Stack Sullivan, the study focuses on the ideas proposed by Joseph Weiss and on control-mastery theory (CMT), a cognitive-dynamic relational theory of mental functioning, psychopathology, and psychotherapy. Unlike other models, CMT stresses that human beings need to feel that both themselves and the people they love are safe; each person, however, may need something different to feel safe. Two clinical vignettes are used to illustrate how the therapist can understand, from the outset of the therapeutic process, how to help the patient feel safe, stressing the case-specific nature of the conditions of safety.

The therapeutic effects of the therapists’ ability to pass their patients’ tests in psychotherapy

Introduction According to Control-Mastery Theory (CMT)—a cognitive-dynamic relational theory of mental functioning, psychopathology, and psychotherapy—patients come to therapy with an unconscious plan to disprove their pathogenic beliefs and achieve adaptive goals. One of the primary ways patients work to disconfirm their pathogenic beliefs is by testing them within the therapeutic relationship. Objectives: The present study aimed to replicate and expand the results of previous studies suggesting that therapists’ responses that disconfirmed patient’s pathogenic beliefs were predictive of patients’ within-session progress. Moreover, we wanted to investigate whether these interventions correlated with the therapeutic alliance. Methods: Transcriptions of 81 sessions from five brief psychodynamic psychotherapies were assessed by 11 independent raters. For each case, the patient’s plan was formulated and tests identified, the accuracy of the therapist’s responses to these tests was rated, and the impact of the therapist’s interventions on the patient’s subsequent communications and their relationship with the therapeutic alliance was measured. Results: The results supported the central hypothesis of the CMT that when the therapist’s interventions passed the patient’s tests, the patient showed signs of improvement. Moreover, the ability of the therapist to pass the patient’s tests correlated with the therapeutic alliance. Conclusions: The clinical implications and the limitations of these findings are discussed, together with the relevance of a good case formulation for clinicians’ optimal responsiveness.

The Plan Formulation Method from Control Mastery Theory and Management of Countertransference.

The aim of this article is to show how the plan formulation method (PFM), an empirically validated method for case formulation based on control mastery theory (CMT), can help clinicians make sense of and use what they feel during sessions to better understand and treat their patients. We give a brief overview of the main psychoanalytic conceptions about countertransference, provide a brief introduction to CMT, and describe the concept of the plan and the PFM. We then show, using several brief clinical examples, how the components of the plan (patient's goals, pathogenic beliefs, traumas, tests, and insights) may help understand clinicians' in-session feelings.

Passing patients' tests-But how? An analysis of therapists' helping skills in response to patient testing.

According to control mastery theory, patients in psychotherapy try to master their problems by disconfirming their pathogenic beliefs. This can be done by testing the therapist. So far, there is hardly any evidence on what concrete interventions or statements of therapists are specifically helpful in passing those tests. In our study, we analyzed the verbal utterances of therapists in test situations to determine whether there is a difference in statements used for passing or failing tests. A total of 168 session transcripts of 21 patients were selected from a total of six therapists, two each in psychoanalytic therapy, psychodynamic therapy, and cognitive behavioral therapy. Test situations were identified, and therapist responses were coded using the helping skills system. There were significant differences in the therapists' reactions to test situations. In particular, closed questions, approval, interpretation, and reflection of the patients' feelings by therapists were associated with a high probability of passing tests. These findings can especially support therapists-in-training to obtain an orientation on how to deal with their patients' test situations that may be perceived as challenging and are important for therapy success while respecting the individuality of their patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Testing of the therapist to reduce maladaptive interactional patterns: Categorizing patients’ tests

ABSTRACT Objective This empirical study undertakes a categorization of the core concept of Control Mastery Theory: mostly unconscious testing of pathogenic beliefs that patients exhibit in relating to their therapist to work on their problems. The focus lays on latent meanings of manifest tests. Method We qualitatively analyze transcripts of 172 psychotherapy sessions with 23 patients for sequences in which significant patient-therapist interactions occur, and systematize identified tests into thematic categories based on what tests intent to achieve (ICC = .68). Guided by theory, the analysis is attending to complexity, individuality, and the unconscious. Results Tests circle around striving for independence, deserving/self-worth, acceptance, and entitlement. Individual tests have various underlying meanings, are interrelated, and may be multidimensional. Conclusion Meanings of tests must be confirmed within the psychotherapeutic process. Incorporating the treating clinician thus seems important.

Toward a More Comprehensive Understanding of Pathogenic Beliefs: Theory and Clinical Implications

According to Control-Mastery Theory, an integrative cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapy process, functional psychopathology derives from pathogenic beliefs. Pathogenic beliefs associates a healthy and adaptive goal to a danger, are generally developed during the developmental period to adapt to traumas and are unconsciously tested by patients in psychotherapy to be disproved. We propose the existence of pathogenic beliefs that are mainly encoded as bodily tensions, sensations, emotions, intensions, mental images and expectations, and only secondarily or not at all as words. These non-verbal pathogenic beliefs painfully affect patients’ bodily states, emotions and behaviours without the patients being able to understand the reasons of their own sensations, reactions and actions. In order to disprove these non-verbal pathogenic beliefs in therapy, it is not enough that clinician help their patients make them explicit; clinicians have also to adapt their overall attitude, non-verbal and paraverbal communications, and to adjust the setting, the nuances and the “atmosphere” of the therapeutic relationship according to the specific developmental traumas that gave rise to these beliefs, the goals thwarted by them and to how the patient test them. The disconfirmation of pre-verbal pathogenic beliefs may also be facilitated by psychotherapy techniques that address the problems of patients on a bodily level. In order to disprove preverbal pathogenic beliefs, an embodied corrective emotional experience is needed.

Understanding interpersonal guilt: Associations with attachment, altruism, and personality pathology.

The aim of this article is to empirically investigate the relationships among interpersonal guilt, as conceived within control-mastery theory (CMT), and attachment, altruism, and personality pathology in an English-speaking sample. An online sample of 393 participants was recruited to complete the Interpersonal Guilt Rating Scale self-report version-15 (IGRS-15s), together with other empirically validated measures for the assessment of attachment, altruism, and personality pathology. On the basis of previous studies conducted in Italian-speaking samples, we hypothesized that survivor guilt, separation/disloyalty guilt, and omnipotent responsibility guilt would be associated with attachment anxiety and avoidance, altruism, and personality pathology; self-hate was hypothesized to be associated only with attachment anxiety and avoidance and personality pathology. Analyses examined bivariate associations as well as the network of partial correlations among variables. The results largely confirmed hypothesized associations, with self-hate evincing the strongest unique association with personality dysfunction. Findings provide a basis for further research regarding interpersonal guilt and personality and relational functioning, with potential implications for clinical conceptualizations of the role of guilt in psychopathology.

When patients probe the analyst: Manifestations of patient testing and its complexity – An in-depth exploration of case examples of extant research

Patients probe the analyst with the goal of challenging pathogenic adaptations to early experiences. As the core concept of control mastery theory (CMT), testing is contextualized within psychoanalytic theory. The current work examines 29 articles illustrating therapies performed or analyzed using the CMT approach for the occurrence of testing, which takes place through interaction, self-presentation, narratives, or the use of the setting. The various manifestations of testing and their potential meanings are described. An in-depth analysis of selected testing examples is performed to compare tests within patients and across studies. The results show that patients differ in their testing strategies, shift testing strategy during the process of treatment, combine tests, and test multiple conflictual themes within a single test. Therefore, the importance of applying a case-specific approach, based on a thorough understanding of a patient, becomes evident. Recommendations concerning psychoanalytic technique, including the role of interpretation, as illustrated in case vignettes, are introduced.

Understanding and Working with the Effects of Parental Pathological Projective Identification

ABSTRACT The present paper outlines parental pathological projective identification as a form of childhood adversity that some patients attempt to address in psychotherapy. This phenomenon involves a parent’s unconscious relocation of an unbearable state of mind, combined with the interpersonal evocation of such in the child. A child’s effort to deal with this experience may involve the development of pathogenic beliefs about the self. These beliefs subsequently cause difficulties in living and considerable distress. Through understanding the dynamics of parental pathological projective identification, clinicians may help patients to develop insight into the origins of their pathogenic beliefs, along with appropriate corrective experiences. The integration of Control-Mastery Theory with the concept of parental pathological projective identification can facilitate such understanding. A clinical example is provided to illustrate these concepts and their relevance to psychotherapy with adult patients.

Identifying patient verbal coaching in psychotherapy

AbstractAccording to control‐mastery theory (CMT), patients enter therapy with a plan (often unconscious) for how to work on their problems and disconfirm pathogenic beliefs. Patients want therapists to understand their plans and help them master their problems. CMT proposes that patients frequently coach their therapist to get them oriented and attuned to critical aspects of their treatment plan. The theory views patients coaching their therapists as an important part of the therapeutic process. The present study represents the first empirical research on this concept of coaching. It was designed to assess whether trained clinical judges could reliably identify and rate instances of patients coaching their therapists from psychotherapy transcript material. Segments from the beginning sessions of three brief (16‐session) psychotherapy cases were presented to clinical judges to rate on the following dimensions: the degree to which a patient communication is coaching; the degree to which a patient communication is intended to help the therapist understand the plan; and the degree to which a patient communication is intended to influence the therapist's behaviour. The results provide empirical evidence that patient coaching communications can be reliably distinguished from non‐coaching communications. Moreover, there was consensus among clinical judges on both the degree to which a coaching communication was intended to help the therapist understand the patient's treatment plan, and the degree to which a coaching communication was intended to influence the therapist's behaviour. Further research is necessary to better understand the vicissitudes of this coaching dynamic in therapy.