The
History of San Francisco Psychotherapy
Control Mastery theory was originated and developed by Joseph Weiss
over thirty years ago, and has been empirically investigated by Harold
Sampson, Joseph Weiss, and the San Francisco Psychotherapy Research
Group (previously known as the Mount Zion Psychotherapy Research Group.)
In 1958
Weiss began his investigations through the close review of the process
notes of an analysis. Weiss noticed certain phenomena which could
not be explained by Freud's original theories, but were compatible
with Freud's later writings. He noted, for example, that patients
may acquire insight spontaneously without the therapist's interpretation.
Weiss published his first article, "Crying at the Happy Ending,"
in 1952 (Psychoanalytic Review, Vol 39, p. 333).
In this
one-page article Weiss explored his observation that people could
and did lift their repressions when they believed that it was safe
to do so. In 1965 Weiss was joined by Hal Sampson. They met daily
to collaborate on researching Weiss' theories. Together they have
successfully directed many research projects which test the predictive
powers of Weiss's theory of psychotherapy. Weiss' theory has been
called Control Mastery theory to emphasize a patient's ability to
exercise some control over his mental life and unconscious mind, and
to acknowledge his wish to master traumatic experiences which have
inhibited his development.
The Research Group was started in 1972 to rigorously and systematically
study the therapeutic process. There are currently three active groups,
with over 100 members working on a variety of research projects. In
1986 Weiss, Sampson, and the Research Group published The Psychoanalytic
Process: Theory, Clinical Observation and Empirical Research describing
their work. In 1989 Lewis Engel, a member of the Research Group, published
Imaginary Crimes which describes Control Mastery theory for
the general public. Weiss' second book, How Psychotherapy Works:
Process and Technique was published by Guilford Press in 1993.
In 1990 the Research Group incorporated into an independent nonprofit
organization which offers courses, workshops, and ongoing case conferences
which are open to the public.
Introduction
to Control Mastery Theory
Control Mastery theory assumes that the patient's problems are rooted
in the grim, constricting pathogenic beliefs that the patient acquires
in the traumatic experiences of childhood. The driving force behind
the psychotherapeutic process is the patient's conscious and unconscious
desire to recover the capacity to pursue life goals by gaining control
and mastering self destructive patterns of thoughts and behaviors.
Control
Mastery theory, based on Freud's later writings, emphasizes a child's
urgent need to adapt to reality. His best strategy for doing this
is to get along with his parents. Therefore he is motivated to maintain
ties to his parents. He needs his parents for survival, safety, love,
and security. In order to maintain these ties a child works to learn
as much as possible about his parents. He infers the moral and ethical
principles which govern his parents' lives, which they practice in
relation to him, and which they expect him to practice in relation
to them. A child must know his parents' whims, needs, and desires.
He examines his parents closely in order to sort out what they want,
expect, and will allow. Because for a child it is a matter of life
and death that he gets along with his parents, he condemns inside
himself any impulses, attitudes, goals or affective states which he
believes might threaten his ties to them.
Pathogenic
Beliefs
The child's
observations and inferences are the basis of conscious and unconscious
beliefs that he uses to guide him in daily activities. Some of these
beliefs are maladaptive and significantly constrict his ability to
develop and function successfully in the world. These beliefs are
referred to in Control Mastery terms as pathogenic beliefs and are
the basis of the development of most psychopathology. They arise from
traumatic interpersonal relationships. These experiences give rise
to unconscious convictions about how one must behave in order to avoid
the danger of re- traumatization. The pathogenic beliefs are irrational
explanations about how one's behavior caused the trauma to occur.
The child's irrational self-blame and unconscious guilt stem from
the responsibility one assumes for anything bad that happens to oneself
or loved ones. These beliefs are powerful. They compel one to behave
in certain ways or prohibit certain kinds of behavior. These beliefs
warn the child that if he attempts to exercise certain essential functions,
or reach certain essential goals, he will put himself in some kind
of danger and so risk feeling fear, shame, guilt, loss or remorse.
As these beliefs are overgeneralized by the child, not only to the
setting in which the trauma occurred but to the world at large, they
significantly influence all future personality development.
How
Do These Pathogenic Beliefs Develop?
Children
are highly motivated to be like, to obey, and to be accepted by their
parents. Children will develop unconscious guilt about wanting to
pursue any developmental goals that they perceive as weakening their
ties to their parents - by for example harming them or provoking punishment
from them. Children greatly exaggerate how their impulses, feelings,
thoughts, and actions affect others or bring harm to themselves. Because
they are egocentric, children have difficulty understanding that the
people around them have feelings, attitudes and behavior patterns
which have been caused for reasons independent of them.
Pathogenic
beliefs stem from a number of sources including identifications with
a parent's pathogenic belief or in compliance with a parent's interpretation
of reality. The kinds of beliefs a child develops depends on the nature
of his specific motivations at the time the beliefs were created.
It also depends on how the child believes his parents reacted to his
motivations. For example, it depends on which of the child's traits
or attitudes seemed to upset his parents, and how they displayed their
displeasure. The child's beliefs may be incorrect inferences about
their parents' motives, misunderstandings, or they may be accurate
assessments and perceptions of the real situation. For example, an
ill child who is kept in may incorrectly infer that his parents want
him to remain dependent on them.
Examples
of Pathogenic Beliefs
Several
examples of pathogenic beliefs are presented below. Each example,
however, reflects only one of the many, varied beliefs a child may
develop.
Consider
for example, a child who observes his parents becoming depressed or
worried after he becomes more independent or displays more strength.
That child may develop the pathogenic belief that his parent would
be upset, hurt, or depressed if he was to become still more independent
or feel even stronger. He might develop symptoms, such as a phobia
which would require him to stay close to home. In Control Mastery
terms this person would be conceived of as suffering from separation
guilt. This stems from the belief that a parent would be hurt by the
child's attempts to separate and have an independent life.
A child
whose parents deprive themselves and appeared to become upset if the
child achieves things for himself, might come to believe that his
parents do not want him to have more in life than they did. He may
deny himself good things in life so as to avoid getting more than
his parents. In Control Mastery terms, this person would be conceived
of as suffering from survivor guilt. This is based on the belief that
there is only a certain amount of the good things in life to go around.
Therefore the child fears that his achievements are stolen from his
family members.
If
a child's parents have experienced very little career success, the
child may develop the symptom of a work inhibition. He fears that
his family would be hurt if he were more successful in work than they.
If
a child's parents seemed drained, burdened or overwhelmed, following
the child's attempts to be close, or get help, the child may develop
the belief that there was something wrong with him that caused his
parents to be drained, burdened or overwhelmed by him. He might develop
the symptom of a reluctance to complain or express his needs for fear
of draining his parents.
Control
Mastery theory doesn't deny the existence of instinctual wishes, however
a child's fear of the loss of her parent is an extremely powerful
force. Children may come to believe that they must give up their own
goals or desires in order to protect their parents and themselves.
They will suppress all actions that they have inferred will cause
their parents to punish them, or be hurt or upset by them.
Retrospective
Development of Pathogenic Beliefs
Children
may also come to retrospectively blame themselves for causing a traumatic
event and will inhibit whatever major goal they were attempting to
pursue at the time. For instance a child who had enthusiastically
begun to explore the world, when a parent took ill, might inhibit
his future exploration for fear of further hurting the parent. A child
does this because he attributes a causal relation between his attempts
to gratify an impulse and the traumatic event. He will repress the
impulse or goal to prevent further trauma.
Children
tend to endow their parents with supreme authority. They have no prior
experience by which to judge their parents' behavior. Since parents
are such an important part of their lives, children want to consider
their parents trustworthy, powerful, and wise. They want to be proud
of them, emulate them, comply with them and be loyal to them. Their
intense need for their parents causes them to suppress any belief
that the parent is malicious or purposefully harmful. Children instead
develop the belief that they deserve any bad treatment they receive
from their parents. For example, they may assume that they deserved
to be punished because they were pursuing a particular developmental
goal. They hope by abandoning the goal they will avoid the bad treatment
and get along with their parents.
Overcoming Pathogenic Beliefs:
How do Patients Work in Treatment to Overcome these Crippling Beliefs?
Testing, Identification and Insight
Control
Mastery believes that patients regulate their own treatment. They
work in therapy to disconfirm their crippling pathogenic beliefs.
Patients are made miserable by these beliefs and are highly motivated
to disconfirm them. Patients think unconsciously about their problems,
and make and figure out plans for disconfirming these beliefs. Symptoms
such as compulsions or inhibitions can now be understood as efforts
to avoid dangers foretold by the pathogenic beliefs. One way that
patients work to disconfirm their pathogenic beliefs is by testing
them in relation to the therapist. This is a way for patient's to
reevaluate the reality basis for the dangers predicted by the pathogenic
beliefs. In testing, a patient acts in accordance with his pathogenic
belief. Patients test in order to ascertain if the conditions of safety
exist for making their beliefs conscious. For example, if a child
believes that his parents were overly worried, he assumes that he
must have done something wrong that caused them to worry. To test
his belief, he will act worrisome with the therapist. He hopes that
the therapist will not be worried. This would help him to disconfirm
his pathogenic belief that he caused his parents to worry.
If
the patient succeeds by testing the therapist, to disconfirm his pathogenic
beliefs, he may then feel safer to lift his repressions and denials.
This would allow the patient to become much more aware of his pathogenic
beliefs and whatever impulses, attitudes, goals, or affective states
he has repressed in obedience to these beliefs. Typically patients
do not want to face core issues until they are reassured that it will
be safe to do so. For example, a patient who was impaired by the belief
he deserved to be blamed by his parents may not remember being blamed
until he assures himself that the therapist will not blame him in
the same manner that his parents did.
Unconcious
Plans
Patients
test according to unconscious plans which gives them a general direction.
These plans are ways of achieving therapeutic goals by mastering the
effects of trauma through overcoming the internal obstructions that
interfere with the pursuit of goals. The plan tells the patient which
beliefs to test first and which to defer testing until later. It is
not a fixed plan, rather a tentative, flexible strategy for achieving
one's goals. It is modified and revised as the therapy progresses.
In fact, the patient will often mold his plan to the therapist's style,
stance, or orientation.
The
therapist uses his inferences about the patient's plan to guide his
interventions. It is crucial that the therapist observe the patient's
responses and subsequent material in order to assess the accuracy
of his inferences. The therapist must be prepared to change his inferences
as new material emerges. The therapist's provisional inferences are
extremely orienting. The therapist is then prepared to recognize the
patient's tests and know how to pass them. If the therapist passes
the initial, less difficult tests and so begins to disconfirm his
pathogenic beliefs, the patient may be able to present more difficult
tests with some degree of certainty that the therapist will also pass
them. Passed tests challenge a patient's conviction of the reality
of their perceived dangers. Patient's are relieved and strengthened
when the therapist deals with the patient's testing correctly.
Two
Kinds of Tests
There
are two kinds of tests, transference tests and tests by turning passive
into active. I will describe them both. In transference repetitions,
a patient reproduces with the therapist those behaviors that he believed
provoked his parent's traumatic reactions. He invites the therapist
to react in the same traumatizing way his parents did. For example
a patient, who in childhood believed that his parents enjoyed lecturing
him, might invite the therapist to worry about him to see if the therapist
appears to enjoy lecturing and telling him what to do. If the therapist
does worry or lecture, the patient infers that the therapist likes
being the authority and feeling needed. He then fears that the therapist
would be threatened by him when he comfortably pursues his own goals.
The patient hopes that he will not affect the therapist in the same
way that he fears he had affected his parents. If this appears to
be the case, the patient may then move toward disconfirming his beliefs
that he caused his parents' traumatizing reactions.
The
second type of testing is turning passive into active. If the patient
enacts drama after drama and presents crisis after crisis, it is likely
that he is presenting the therapist with the opportunity to experience
and feel firsthand the situations such as those which were traumatizing
to him as a child. The pull into action must be experienced as a challenge
in order to evoke a role model. In turning passive into active, the
patient treats the therapist in the same manner in which he had been
treated and found traumatic. The patient hopes that the therapist
will not be traumatized and instead will be better able to deal with
the behavior than the patient was. The patient may then identify with
the therapist's capacity to withstand bad treatment such as indifference,
false accusations, blame and attacks.
In
addition to testing, patients also work in treatment by making use
of the therapist's interpretations to become conscious of the pathogenic
beliefs and to realize that they are false and maladaptive. This increases
the patient's control over the effects of their beliefs. They may
then become less constrained by the beliefs and less vulnerable to
the kinds of trauma to which they were exposed by the beliefs.
Control
Mastery theory emphasizes the cooperative working relationship between
therapist and patient to disconfirm his pathogenic beliefs. The patient
is highly motivated to disconfirm his crippling beliefs in order to
recover the capacity to pursue life goals. This theoretical orientation
is applicable to all types of treatments and patients including analysis,
brief psychotherapy, marital, family, child, and crisis work. The
way a therapist deals with any type of patient is case specific. It
depends on the particular beliefs that the patient has developed,
on which belief the patient is working on at a particular time and
the patient's particular way of working. The addition of the research
component of Control Mastery offers a unique, and exciting opportunity
to clarify the theory and to discover if the data of observation supports
or refutes what the theory has taught us to expect.
Our
Research
Over
one hundred researchers and clinicians worldwide now participate in
the ongoing work of the research group. Well over 100 papers have
been published which present research or explore new directions for
study of Weiss's theory.
In 1986
much of this research was collected and presented in a groundbreaking
volume entitled, The Psychoanalytic Process: Theory, Clinical Observation
and Empirical Research, authored by Weiss, Sampson and the Mt.
Zion Research Group (Guilford Press). In the fall of 1993, Weiss published
an important new contribution to psychotherapy and psychoanalysis
entitled, How psychotherapy Works: Process and Technique (Guilford
Press). In this volume, Weiss extends his powerful theory and focuses
on its clinical applications.
The
research group currently offers weekly research group meetings where
members collaborate on the formulation and clarification of hypotheses,
design of studies and interpretation of research findings. Clinical
case conferences are held weekly to provide professionals the opportunity
to explore and understand clinical case material. Classes and colloquia
are offered each semester to allow for in depth study of the basic
theory and its application to special populations. Annual conferences
provide a forum for discussion with esteemed colleagues on special
interest topics. Lastly, a yearly week long workshop is offered the
first week in March, for intensive survey of the theory, research
methods and clinical applications.
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