Articoli Scientifici

This article aims to give the reader an overview of the concept of omnipotent responsibility guilt, which, according to control-mastery theory (CMT), is the emotional manifestation of a set of pathogenic beliefs that make people believe that if they put their needs in the foreground and do not try to satisfy the needs of their important others, their significant others will suffer. These pathogenic beliefs were generally developed to adapt to early traumatic and adverse experiences, that is, experiences that disrupted the patient’s sense of safety in acute, systematic, or chronic ways. In the case of people with omnipotent-responsibility-related pathogenic beliefs, among these experiences, we find parents with physical or psychological problems, parents who were victims of accidents, parents who were separated or were mourning some loss and wanted their children to take care of them, and situations where parents reversed their roles with their children. Omnipotent responsibility guilt correlates with different forms of psychopathology, such as depression, obsessive-compulsive disorders, and anxiety disorders, and with several transdiagnostic features, such as worry and low self-esteem. We describe some clinical exemplifications to show how, according to the CMT, patients with pathogenic beliefs supporting omnipotent responsibility guilt can try to become aware and disprove these pathogenic beliefs and master their traumas in psychotherapy, and how therapists can help them have the corrective emotional experiences they need to get better.

Le riflessioni che presento si collocano nella scia di un precedente lavoro, in cui era stato posto un quesito rispetto a questo tipo di fenomeni. In particolare, mi riferisco a quelle circostanze, che si verificano in terapia, in cui “la disconferma delle credenze patogene lascia spazio a un nuovo vissuto doloroso: la perdita di quei riferimenti identitari che, per quanto portatori di sofferenza, offrivano un’immagine chiara di sé” (Bruno, 2025). I concetti di vero Sé e Falso Sé, introdotti da Winnicott (vedi, ad esempio, Winnicott, 1965), offrono spunti, a mio avviso, rilevanti per comprendere quei pazienti che, in seguito a un lavoro terapeutico volto a disconfermare le loro credenze patogene e al raggiungimento di obiettivi sani attraverso il superamento dei test, riferiscono di sentirsi vuoti, “dissociati”, lontani dal mondo e dagli altri, persi, confusi o, più genericamente, “in crisi”. Da una prospettiva psicoanalitica, il vero Sé rappresenta il costrutto ipotetico alla base della sensazione di essere sé stessi, di essere autentici, spontanei e creativi, e il suo sviluppo è reso possibile dalla presenza di un ambiente facilitante che, nell’infanzia, è in grado di favorire la continuità del senso di esistere del bambino, il suo abitare il corpo, il suo essere sé stesso e al tempo stesso in relazione con l’ambiente (Winnicott, 1965). Tale ambiente facilitante consente il passaggio da una dipendenza assoluta a una dipendenza relativa, accompagnando gradualmente il bambino nel processo di separazione dalla madre e di acquisizione dell’autonomia. Quando tutto ciò viene meno e i genitori non rispondono in modo adeguato, empatico e contingente ai suoi bisogni, la situazione si complica. Il bambino, infatti, nel tentativo di proteggere il legame con i caregiver, impara precocemente a adattarsi, modificando e distorcendo i propri bisogni, desideri, comportamenti e atteggiamenti per adeguarsi alle aspettative altrui.

The sense of emptiness is still a poorly defined construct in the literature, yet it is frequently reported in individuals with borderline personality disorder, depressive symptoms, and narcissistic personality disorder. This paper aims to replicate those research studies showing that there are significant correlations between emptiness, insecure attachment styles, maladaptive childhood experiences, shame, impulsivity, depression, and borderline and narcissistic personality features. Additionally, it was hypothesized that a significant correlation would exist between the sense of emptiness and burdening guilt and self-hate, and that self-hate would mediate the relationship between adverse childhood experiences and preoccupied attachment and sense of emptiness. The sample consisted of 128 Italian participants recruited online, who completed a battery of self-report questionnaires designed to measure the psychopathological features described above. The sense of emptiness was strongly correlated with depression (rho 0.81, p

This paper aims to identify the core assumptions of the control-mastery theory (CMT) – those assumptions whose falsification would determine the abandonment of the theory itself. These concepts are the adaptive nature of basic human motivations; the sophisticated and adaptive nature of unconscious mental functioning; the overarching role of safety in the regulation of conscious and unconscious mental functioning; the prosocial nature of certain basic human motivations; the centrality of beliefs for understanding how human beings relate to reality and other human beings; and the ontological unity of the human Self. We show how the application of these assumptions to clinical phenomena that apparently contradict them has given rise to the more innovative concepts of the CMT – such as the concept of patients’ tests, coaches, and plans – and has emphasized the centrality of guilt and shame in psychopathology. In contrast to the core concepts delineated above, modifying these derived concepts would not imply modifying the entire theory. Finally, we show how these concepts shape the clinical work of therapists who embrace the CMT.

Di narcisismo si è parlato e scritto tanto. Il primo a introdurre tale concetto in psicoanalisi è stato Freud nel 1914 con il suo scritto “Introduzione al narcisismo”. Kohut (1977), a differenza di Freud che vedeva il fenomeno del narcisismo come un investimento libidico dell’Io e come una fase dello psicosessuale il cui superamento è essenziale per accedere alla salute mentale, propone l’esistenza di un narcisismo sano che si manifesta, nelle diverse fasi dello sviluppo, in forme diverse, e che comprendere i bisogni di ammirazione, idealizzazione e fratellanza tipici di tutti gli esseri umani. Lo sviluppo di un disturbo narcisistico, in quest’ottica, deriverebbe dall’incapacità dei genitori di fornire al bambino adeguate risposte empatiche, incapacità che può tradursi in critiche eccessive, svalutazione, trascuratezza, difficoltà a incarnare un ideale per il piccolo ecc. Nel DSM-5TR (APA, 2015), oltre ai criteri diagnostici connessi alla presenza di grandiosità, fantasie ipertrofiche, costante necessità di ammirazione, mancanza di empatia, arroganza e invidia, le persone con Disturbo Narcisistico di Personalità mostrano un’eccessiva vulnerabilità alle critiche, sentimenti intensi di rabbia, vergogna e senso di umiliazione, mancanza di consapevolezza del proprio comportamento e delle difficoltà che crea negli altri e difficoltà a stabilire relazioni interpersonali profonde e durature.

Guilt and shame are emotions that, albeit subjectively negative, help humans adapt to their social environment. However, in some cases, there are pathogenic beliefs, shaped over the lifespan that sustain them and make them a source of psychopathological suffering. In this paper we will first briefly show how Control‐Mastery Theory (CMT) considers several types of pathogenic beliefs shaped by traumatic experiences that underly chronic feelings of guilt and shame. We then focus on a clinical case of Livia, a 28 year‐old woman with relational and academic problems suffering mainly from two such types of pathogenic beliefs: burdening guilt and disloyalty guilt. We describe how a) Livia was driven by adverse and traumatic experiences to form some of these pathogenic beliefs, b) how she tested the therapist in order to discover whether he would disconfirm these beliefs, and c) how the therapist was able to successfully pass these tests and provide her with new and healthier interpersonal experiences. The case of Livia will highlight therapists' ability to accurately formulate patients' goals, pathogenic beliefs—including types of guilt‐ and shame‐related beliefs—and traumas. Moreover, the case will illustrate how therapists can pass patients' tests and adopt the right attitude to help patients disprove their pathogenic beliefs and overcome problematic experiences of guilt and shame.

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 wer 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.

This article aims to highlight how chronic couple conflictuality can be read from the control-mastery theory perspective. Some empirically grounded couple conflictuality models are reviewed and discussed, particularly regarding researchers’ tendency to focus on specific ways of dealing with conflicts, and the presence of a specific relational pattern, the demand/withdraw style, which seems to be particularly present among high-conflict couples. The article further presents an overview of the psychodynamic and systemic literature on couple conflictuality, in which three basic ways of reading conflict emerge: as an outcome of projective identification mechanisms; as a consequence of deficits in mentalization and affective regulation; and as a breakdown of dysfunctional communication strategies. The main control-mastery theory concepts also are presented, with a particular focus on its application to couple conflicts. According to this perspective, chronic couple conflictuality results from the repetition of vicious relational circles—that is, mutually failed tests by partners that give rise to negative escalations and couple dissatisfaction. A sample of clinical material from couple therapy is presented to exemplify this idea.

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.

Il conflitto coniugale è uno degli aspetti più studiati delle relazioni di coppia (Gottman, 2014) in quanto fattore che si associa a sentimenti, cognizioni e pensieri negativi per le coppie e le famiglie; gli affetti principali connessi al conflitto sono irritazione, delusione e risentimento (Sears, Repetti, Reynolds, Rebels & Krull, 2016; Manalel, Birditt, Orbuch, & Antonucci, 2019). Il conflitto è considerato un fattore di rischio generico che impatta sul benessere sia mentale, sia fisico, sia familiare (per una panoramica, Fincham & Beach, 1999); dal punto di vista della salute mentale, alcune ricerche evidenziano una relazione tra conflitto e sviluppo di depressione, disturbi alimentari e abuso di alcol in uno o entrambi i partner (Beach, Fincham, & Katz, 1998; Van den Broucke, Vandereycken, & Norre, 1997; O’Farrel Choquette, & Birchler 1991), che contribuirebbe secondo alcuni autori ad alimentare interazioni ancora più aggressive e asimmetriche (Snyder & Whisman, 2003). Vi sono evidenze di come tensioni e ostilità coniugali abbiano un impatto negativo anche sulla salute fisica, in particolare su alcune malattie come il cancro, i disordini cardiaci e il dolore cronico (Schmaling & Sher, 1997). Si è osservato, inoltre, che il conflitto di coppia, in particolare se connotato da ostilità verbale, ha un impatto importante sull’adattamento e sul benessere emotivo dei figli (Cummings, Vallard, El Sheikh, & Lake, 1991), oltre che sulle loro capacità di problem-solving, senso di autoefficacia (Bernier Jarry-Boileau, & Lacharité, 2014) e stile di attaccamento (Owen & Cox, 1997).

In the classical psychoanalytic tradition, the patient is seen as unconsciously governed by forces that are at odds with the healing process. But over the years, the concept of resistance against change has been subjected to modifications, and the patient’s contribution to the therapeutic relationship has come to be seen as more oriented to a conscious and unconscious collaboration with the clinician. This article aims to explore a new way of understanding how progress in psychotherapy is achieved and to reframe the therapeutic relationship from the point of view of Control-Mastery Theory (CMT). According to CMT, people are motivated to achieve adaptive goals, to master their traumas, and to feel better; to this purpose, patients unconsciously assume proactive roles in the therapeutic process. Indeed, they work during therapy to disprove their pathogenic beliefs, testing them in the therapeutic relationship, and helping the therapist through coaching behaviors, attitudes, and communications aimed at providing helpful information to understand the components of their own unconscious plan.

The aim of this article is to introduce the reader to how control-mastery theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993), an integrative relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapeutic process, understands traumas, their consequences, and their mastery. In the first part of this article, we will present an overview of the debate about the definition of trauma within the different editions of the Diagnostic and Statistical Manual of Mental Disorders. Then, we will focus on the concept of complex traumas and on their consequences on mental health. Finally, we will discuss how CMT conceptualizes traumas and their pathological consequences. We will stress in particular how, according to CMT, in order for a painful experience to become a trauma, its victim has to come to believe that s/he caused it in the attempt to pursue a healthy and adaptive goal. In order to master traumas and disprove the pathogenic beliefs developed from them, people attempt to reexperience situations similar to the traumatic ones in safer conditions while giving them happier endings.