Personalizing Psychotherapy for Personality Disorders: Perspectives From Control-Mastery Theory

While several empirically supported models for treating personality disorder (PD) are available, researchers and clinicians have continued to advocate for the personalization of psychotherapy to the particular needs and characteristics of the individual patient with severe personality pathology. Control-Mastery Theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986) provides a useful framework for understanding personality pathology, and for guiding treatment with individualized case formulation. The present article introduces the basic concepts of CMT and their application in personalizing psychotherapy for patients with severe PDs. According to CMT, patients come to therapy in order to disprove the pathogenic beliefs that obstruct their pursue of healthy and adaptive developmental goals. These pathogenic beliefs were developed to adapt to early traumatic experiences, but end up causing further suffering, inhibitions, and symptoms. For this reason, patients test these pathogenic beliefs within the therapeutic relationship in search of corrective emotional experiences that disprove them. Among patients with severe PDs, such beliefs may be reciprocally contradictory and may be enacted in therapy in multiple different ways, often challenging therapists to respond appropriately. CMT suggests that therapists’ formulation regarding a given patient’s plan—including the nature of the patient’s goals, traumas, pathogenic beliefs, and testing strategies—allow for a personalized approach that will optimize therapy effectiveness.