Control Mastery is a cognitive-relational theory of psychotherapy first developed by Joseph Weiss, M.D., and later tested empirically by Weiss and Harold Sampson, Ph.D., and other members of the San Francisco Psychotherapy Research Group (SFPRG). The name comes from Weiss’ attempt to both credit Sigmund Freud with having developed the basic concepts of ego psychology, upon which Control Mastery Theory rests, and distinguish his theory from Freud’s, especially Freud’s earlier drive theory (1971). “Control” refers to one tenet of Weiss’ theory that, even today, is quite revolutionary. It refers to the assumption, later tested and shown to have validity, that the patient in therapy “exerts considerable control over his unconscious mental life,” and that the patient works in psychotherapy to “make conscious the mental contents that he has warded off so that he can put them under conscious control” and actively work to solve his problems (1976). “Mastery” refers to the patient’s inherent “wish to master traumatic experiences that have inhibited his development” (1990).
Control Mastery Theory (CMT) presents psychopathology in humanistic, non-judgmental language, placing adaptation and attachment as the two central organizing principles in the development of the individual. Also fundamental to the theory is the principle that people have an inherent wish to overcome their problems and to develop into healthy, productive adults.
CMT is also a theory of mind, and emphasizes a child’s urgent need to adapt to reality. The child’s best strategy for doing so is to get along with his parents. He is therefore 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 allow. Because, for a child, it is a matter of self-preservation that he gets along with his parents, he condemns any impulses, attitudes, goals or affective states inside himself which he believes might threaten his ties to them. It is in this context that the concept of pathogenic beliefs arises.
- 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 maladaptive beliefs are referred to, in terms of CMT, as pathogenic beliefs (beliefs that generate suffering) and are the basis of the development of most psychopathology. They arise from traumatic experiences, usually at an early age. These experiences give rise to unconscious convictions about how one must behave in order to avoid the danger of re-traumatization. Pathogenic beliefs are explanations, however irrational, about how one’s behavior caused the trauma to occur. The child’s irrational self-blame and unconscious guilt stem from the responsibility a child assumes for anything bad that happens to oneself or loved ones. These beliefs are powerful. They compel a child to behave in certain ways or prohibit certain kinds of behavior. These beliefs warn the child that if he or she attempts to exercise certain essential functions, or reach certain essential goals, the child 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, feeling as if they had harmed them, or feeling as if they provoked 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 feelings, attitudes and behavior patterns in people around them were caused for reasons independent of them. Pathogenic beliefs also arise from identifications with a parent’s pathogenic beliefs, or in compliance with a parent’s interpretation of reality. The specific belief a child develops depends on the nature of his motivations at the time the belief was created. It also depends on how the child interprets his parents’ reactions 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 belief may be based on incorrect inferences about his or her parents’ motives, on misunderstandings, or they may be accurate assessments and perceptions of the real situation. For example, an ill child who is kept in the home 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 Theory 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 terms of CMT, this person would be perceived 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, as a consequence, 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 or achieve a goal 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 as 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.
Control Mastery Theory embraces the idea that patients consciously and unconsciously 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 patients to reevaluate the reality upon which the dangers predicted by the pathogenic beliefs are based. In testing, a patient acts in accordance with his pathogenic belief. Patients engage in testing behaviors in order to ascertain if conditions of safety are sufficient enough 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 safe enough 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.Testing, Identification, and Insight
Control Mastery believes that patients consciously and unconsciously 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 patients to reevaluate the reality upon which the dangers predicted by the pathogenic beliefs are based. In testing, a patient acts in accordance with his pathogenic belief. Patients test in order to ascertain if conditions of safety are sufficient enough 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 safe enough 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.
- Unconscious Plans
Patients test according to unconscious plans which give them a general direction in therapy. 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 is a formulation based on prior experiences of safety and danger that determines 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 testing behaviors 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. Patients are relieved and strengthened when the therapist deals with the patient’s testing behaviors correctly.
- Two Kinds of Tests
There are two kinds of testing behaviors, transference tests and tests by turning passive into active. I will describe them both. In transference repetitions — or tests, 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, that the therapist was not affected in the way his parents seemingly were, the patient may then move toward disconfirming the beliefs that he caused his parents’ traumatizing reactions.
The second type of testing behavior 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. This “pull into action” must be experienced by the therapist as a real challenge in order to evoke in the patient a sense that the therapist is a role model for new behavior. In turning passive into active, the patient treats the therapist in the same manner in which he had been treated by his parent(s), and which he found traumatic. The patient hopes that the therapist will not be traumatized, but instead will be better able to deal with the difficult 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 engaging in testing behaviors, 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; psychodynamic psychotherapy; Cognitive Behavioral Therapy; brief psychotherapy; marital, family and child therapy; 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.
Over one hundred researchers and clinicians worldwide have participated in the 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. Click Here for more information
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