Transformative Relationships

The Control Mastery Theory of Psychotherapy

George Silberschatz

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780415861113
  9780415950275
• Edition: 1
• eBook ISBN:
  9781135417116
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The control-mastery theory, developed by Dr. Joseph Weiss over the second half of the twentieth century, is an attempt to integrate an understanding of how the mind works, how psychopathologies develop, and how psychotherapy can effectively help. 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. Underlying this theory is the conception that the client structures (both consciously and unconsciously) the psychotherapeutic process in order to clearly and quickly address her own goals. Following this line of thought, the practitioner must be able to identify a client's aims, respond to and encourage these thoughts, and develop a strategic therapeutic plan to effectively address the needs and wants of each individual. This book aims to present the control-mastery theory in a more accessible format, and introduce it to a wider audience, expanding the scope of the theory beyond simply a comparison to Freudian analysis. The text presents an integrated cognitive-psychodynamic-relational approach to therapy, addressing issues surrounding psychopathology and pathogenic constructions. Organized into three distinct sections, the book first considers theoretical underpinnings before moving into in-depth discussions of clinical and practical application of these valuable therapeutic tools and techniques, drawing heavily on detailed descriptions of entire therapy sessions. The final section of the book covers current and developing empirical research, presenting convincing arguments in support of the theory and practice earlier discussed. The editor has extensive research and clinical experience with both the conceptual and practical aspects of the theory, and has worked with Joseph Weiss and Hal Sampson - the two pioneers of the control-mastery approach - who each contributes a chapter to the book. Transformative Relationships advances this integrative approach to therapy beyond its current scope, introducing these valuable concepts and techniques to a wider audience of practitioners of all backgrounds.

Part I
Theory

1
THE CONTROL-MASTERY THEORY

George Silberschatz

My purpose in this chapter is to provide an overview of the control-mastery theory. All of the theory's concepts will be described and illustrated with brief examples so that a reader who is new to this approach can develop a sufficient familiarity with it to follow its application and understand its clinical implications, which are described in the subsequent chapters of this volume. In the interest of conciseness and clarity, I will not focus on the evolution of the control-mastery theory or how it relates to other theories. The interested reader is referred to Silberschatz, Curtis, Sampson, & Weiss (1991), Weiss, Sampson, and the Mount Zion Psychotherapy Research Group (1986), Weiss (1993), and to chapters 10 and 12 of this volume.

I will first describe how control-mastery theory explains the development of psychopathology, i.e., the concept of pathogenic beliefs. Then I will discuss the patient's “plan” for therapy, which is based on the idea that patients are motivated in an organized way to master their conflicts and solve their problems. A discussion of how patients and therapists work together to disconfirm pathogenic beliefs then follows. The last section is a brief discussion of how the control-mastery theory relates to several prominent clinical concepts such as the therapeutic alliance, transference, resistance, psychotherapeutic technique, and the corrective emotional experience.

HOW PSYCHOPATHOLOGY DEVELOPS

Control-mastery theory begins with an assumption that is prevalent in modern biology, ethology, and the behavioral sciences: the adaptive imperative. All animals, according to this imperative, are motivated—indeed, they are predisposed (“hardwired”) by evolution—to adapt to their environment. For humans (and most mammals), survival and adaptation require maintaining a stable connection or attachment to parents, family members, or other caregivers (Bowlby, 1969, 1973, 1980, 1988, 1989). A key to adaptation in humans is the formation of a reliable conception of reality, an internal map of the physical and interpersonal world. This map-making process begins early in infancy (for further discussion, see chapter 10), and one of the primary ways we develop our map of reality is by forming and testing hypotheses about how the world works (Gopnik, Meltzoff, & Kuhl, 1999; Stern, 1985, 2002; Weiss, 1993). In other words, in order to adapt to our environment we develop beliefs about our family, our relationships, our world, and ourselves. This process of developing and testing beliefs begins shortly after birth and continues throughout life.

Another fundamental assumption of control-mastery theory is that human behavior is regulated by perceptions of safety and danger (see chapters 2 and 3). These perceptions are an integral part of the mapmaking process. In order to develop a reliable and useful conception of reality, the individual must frequently assess his internal and external world to determine which experiences are safe and which are dangerous. Traumatic emotional experiences are, for example, experiences of danger. Indeed, according to this model, trauma is defined as any situation that overwhelms a person with anxiety or fear, or that leads a person to believe an important goal must be renounced in order to avoid the danger of hurting loved ones or the danger of being hurt by them.

The control-mastery theory of psychopathology builds on these fundamental assumptions. Weiss (1986, 1993) posited that psychopathology stems from pathogenic beliefs (maps) that typically stem from traumatic childhood experiences. These beliefs, which are usually unconscious, are extremely frightening and constricting because they suggest that the pursuit of an important goal is fraught with danger. For example, a single, middle-aged man who lived with his elderly mother was traumatized early in life by his mother's chronic unhappiness and frequent bouts of severe depression. When he was a young boy, he noticed his mother became very sad when he left for school, and he concluded that his leaving caused her depression. He quickly developed a severe school phobia that consequently restricted him to staying at home with his mother. What initially appeared as a fear of school was in fact based on the pathogenic belief that if he separated from his mother (i.e., left her alone while he was in school) she would become sad or depressed. By the age of 10 or 11, the patient showed signs of depression that persisted into his adulthood and that ultimately led him to seek psychotherapy.

The brief example described here illustrates several important aspects of pathogenic beliefs. The patient formed his belief as part of an effort to adapt to his environment (growing up with a depressed mother) and in an effort to preserve a stable relationship with his mother. The belief was strongly influenced by his perception of danger. Leaving his mother to go to school or play with friends was dangerous because she would become depressed. He also developed a distorted view about his ability to affect his mother's emotional states. By staying at home with her, he felt he could cheer her up and prevent her depressive feelings. His occasional success at staving off mother's depression led him to feel excessively responsible for her moods. Thus, when she was sad or depressed (a very frequent occurrence), he came to believe that it was his fault and that he should have been able to do something to prevent her unhappiness. The patient's depression stemmed from self-punitive feelings (he punished himself because he was unable to “cure” his mother) and represented a powerful, unconscious identification with his depressed mother. By unconsciously identifying with her, he punished himself for failing to “cure” her. Thus, what began as an adaptive effort to form a map of reality soon became maladaptive—indeed, pathogenic—because it forced him to renounce crucial developmental goals (e.g., appropriate separation and individuation, attending school, developing friendships), led to exaggerated feelings of responsibility and self-blame, and ultimately resulted in severe psychopathology.

Clinicians from various theoretical perspectives frequently have an intuitive understanding of the pathogenic belief concept. A patient who has difficulty expressing anger, for instance, is frequently ruled by a pathogenic belief that angry feelings would wound or destroy a loved one. A person who suffers from work inhibitions and who sabotages his or her own success often has the unconscious pathogenic belief that success would be injurious to a loved one. Individuals who experience physical or emotional abuse in childhood often develop a pathogenic belief readily familiar to most therapists, regardless of their theoretical orientation. The abuse victim typically believes that he or she was “bad” and deserved the treatment he or she received at the hand of his or her abuser (Suffridge, 1991). Like all pathogenic beliefs, this belief begins as an effort at adaptation (Rappoport, 1996; Weiss, 1993). In order to survive, the abused child needs his parents, even if they are hurting him. Consequently, he would prefer to see himself as bad or flawed rather than see his parents as being flawed. Fairbairn (1943/1952) articulated this same idea far more poetically when he said that, for a child, it is safer to be a “sinner in a world ruled by God than to live in a world ruled by the Devil. A sinner in a world ruled by God may be bad; but there is always a certain sense of security to be derived from the fact that the world around is good …” (pp. 66–67). However, this irrationally self-blaming belief ultimately leads to psychopathology because a person who believes (consciously or unconsciously) that he or she is flawed and deserves to be mistreated frequently becomes involved in abusive or destructive relationships and suffers from depression, severe anxiety, self-destructive behavior patterns, and/or personality disorders.

A person's response to trauma—and his or her propensity to develop pathogenic beliefs in response to it—is influenced by a variety of factors, such as personality and temperamental variables, the specific nature of the trauma, and the familial or social context in which the trauma occurs. Thus, siblings who grow up together with the same parents may respond quite differently to similar traumatic experiences. Pathogenic beliefs can develop as a result of shock trauma—discrete catastrophic events such as the severe illness or death of a parent, family member, or loved one—or stress trauma, recurrent and persistent traumatic experiences from which the child cannot escape and that force the child to renounce crucial developmental goals.

Let us look more closely at how pathogenic beliefs develop. The child experiences a traumatic event (shock trauma) and is overwhelmed by fear, anxiety, or other disruptive emotions. She is strongly motivated to prevent its recurrence. As part of this effort, she develops a theory to help her determine what she did to cause the event and what she could have done to prevent it. In this theorizing process, she is vulnerable to irrational self-blame and guilt (see chapter 4), because children lack the cognitive ability, experience, and knowledge to understand that their behavior, thoughts, or wishes are entirely unrelated to the traumatic event (see chapter 10).

Consider, for example, a 5-year-old boy whose parents had recently adopted a 2-year-old daughter. The boy bitterly resented the intrusion of a new sister and was particularly upset that his mother, with whom he had been very close, seemed to be spending an inordinate amount of time with the new intruder. The boy openly expressed his anger and displeasure, frequently yelling at his mother to “take her [sister] back where she came from.” Several months after the adoption, the mother and adopted daughter were in a serious car accident, resulting in a 2-week hospital stay for the mother and a 6-week hospitalization for the little girl. The boy and his father had a very difficult time coping with this traumatic event. The boy became sullen, withdrawn, phobic, and depressed, while his father started drinking heavily, ultimately losing his job and eventually his marriage. This trauma was a catastrophic event in this young boy's life, and he developed the pathogenic belief that his anger and his wish to get rid of the new sibling caused the accident and the demise of his family. He simply lacked the knowledge and cognitive resources to understand he was not the cause of this family catastrophe. Like most traumatized children, he blamed himself for what occurred and punished himself by his withdrawal from life.

This example illustrates the formation of pathogenic beliefs that stem from false inferences or incorrect theories regarding cause and effect. Indeed, shock traumas typically lead to pathogenic beliefs because of such faulty reasoning. However, children also frequently develop unconscious pathogenic beliefs on the basis of accurate inferences about traumatic experiences. A child whose parents consistently neglected or mistreated him (stress trauma) develops pathogenic beliefs because of the way that he truly was mistreated. Sampson (1992) pointed out that in such instances the child's real experiences produce pathogenic beliefs about morality. Children assume that the ways they have been treated in the past (reality) are the ways they deserve to be treated (morality) now and in the future.

Sampson (1992) also described a study by Beres (1958) of young children who were placed in foster homes. These children inferred that their parents had rejected them and had done so because the child was bad; in other words, the child developed the pathogenic belief that he or she deserved to be rejected. Moreover, the belief that they deserved to be rejected (i.e., a pathogenic belief about morality) “regulated their subsequent relationships. They believed not only that they would be rejected, but that they should be rejected” (Sampson, 1992, p. 518).

Pathogenic beliefs are not dry, intellectualized, abstract thoughts; they are powerful, emotion-laden, painful belief structures that cause severe emotional distress. The child who was emotionally mistreated and subsequently developed the pathogenic belief that he deserved the mistreatment suffers from an emotionally crippling and destructive belief system that includes both an affective and cognitive component (Silberschatz & Sampson, 1991). Pathogenic beliefs are typically unconscious. Patients are frequently unaware of the cognitive aspects of the belief, but they experience the overwhelming anxiety, fear, depression, guilt, self-loathing, and self-destructive impulses, or various other disruptive, constricting emotions that stem from their pathogenic beliefs.

In view of how painful and destructive pathogenic beliefs are, why do they persist? Why would a person maintain beliefs about him- or herself that lead to intense suffering and dysfunction? According to the control-mastery theory, people are highly motivated to relinquish or disconfirm pathogenic beliefs, but they are impeded from doing so by their perceptions of danger. Pathogenic beliefs develop as part of an effort to cope with danger, and they are held in place by a person's ongoing perception of danger (for further discussion of this point, see chapters 2 and 3). Thus, the person holding pathogenic beliefs has a high degree of emotional conviction about them and believes them to be true. He is most likely afraid to test them. In addition, pathogenic beliefs are typically unconscious and therefore not under a person's conscious or volitional control. Finally, pathogenic beliefs are deeply entrenched and have a great deal of momentum or weight behind them. Consequently, considerable evidence and multiple disconfirmatory experiences are required to disconfirm them. In this respect, pathogenic beliefs are no different from other theories or attitudes that a person holds. We typically do not change our theories or fundamental attitudes with a single piece of new information or evidence, even when the evidence is compelling. Most people require repeated instances of new evidence before they can relinquish or alter a cherished theory or worldview.

THE PATIENT'S PLAN

Control-mastery theory assumes that people who seek psychotherapy are motivated to disconfirm or relinquish pathogenic beliefs in order to proceed with normal developmental goals. This primary motivation toward mastering conflict and solving problems is embedded in the concept of the patient's plan. Control-mastery theory posits that patients come t...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Dedication
• CONTENTS
• Contributors
• Acknowledgments
• Introduction
• Part I Theory
• Part II Therapy
• Part III Research and Integration
• Index