Articoli Scientifici

This article aims to offer an overview of our knowledge about separation/disloyalty guilt, a maladaptive kind of interpersonal guilt that derives from pathogenic beliefs that associate the healthy and adaptive goals of being separate, different, and independent from important others with the danger of deeply hurting them. These pathogenic beliefs stem from early relational traumas and adverse experiences, such as having had relatives who showed their children that they were visibly hurt by the attempts at exploration and differentiation from their children. Separation/disloyalty guilt has been shown to correlate with eating disorders, panic disorders, obsessive and phobic disorders, illness anxiety disorder, and with transdiagnostic features such as difficulties in mentalization, emotion regulation, and intolerance to frustration. We describe how patients with separation/disloyalty guilt can look for disconfirmations of these pathogenic beliefs during their psychotherapies and how clinicians can help them have the corrective emotional experiences they need.

A growing body of research documents intergenerational transmission of trauma, attachment, parenting practices, and vulnerability to psychopathology. Another relevant component of psychopathology that may show parent–child associations is maladaptive interpersonal guilt, which may be shaped by parental teachings and role modelling. The present cross-sectional study examined whether parents’ self-reported guilt was associated with children’s self-reported guilt and with parents’ perceptions of their children’s guilt. The sample included 323 parent–child dyads. Parents completed the Interpersonal Guilt Rating Scale-20s (IGRS-20s) and the Interpersonal Guilt Rating Scale—Child Informant (IGRS-18CI); children completed the Interpersonal Guilt Rating Scale for Children (IGRS17C). Spearman correlations revealed significant parent–child associations: parents’ Separation/Disloyalty guilt was positively associated with children’s Separation/Disloyalty and Omnipotent Responsibility guilt, whereas parental Burdening guilt was positively associated with children’s Self-Hate/Burdening guilt. Moreover, parents’ Survivor guilt, Separation/Disloyalty guilt, and Self-Hate guilt were significantly associated with higher levels of the corresponding and related kinds of guilt as perceived in their children. These findings suggest that specific forms of interpersonal guilt may be similarly present in parents and children and highlight the clinical relevance of addressing parental pathogenic beliefs in child psychotherapy.

Vorrei ritornare di nuovo sul concetto di sicurezza (Fiorenza et al, 2023; Weiss, 2005), perché ho l’impressione, da quanto osservo in varie supervisioni e discussioni cliniche, che su di esso vi è una certa dose di confusione.Dal punto di vista della CMT, far sentire un paziente al sicuro è forse l’obiettivo sovraordinato del terapeuta. Il punto è che, dal nostro punto di vista, il senso di sicurezza dei pazienti è funzione o di una loro valutazione realistica della realtà o della natura delle loro credenze patogene, cioè di quelle credenze, in larga parte inconsce, che gli fanno vivere come pericoloso il perseguimento di obiettivi perseguibili, sani e realistici (Gazzillo, 2023; Weiss, 1997).Le credenze patogene sono la base di sintomi, inibizioni e tratti disfunzionali del carattere, e proprio a causa delle sue credenze patogene un paziente ha paura di fare qualcosa che vorrebbe e sarebbe in grado di fare, si sente in ansia alla prospettiva di avvicinarsi a quegli obiettivi e quindi li evita. Ne consegue che, se il terapeuta spinge il paziente a perseguire quell’obiettivo, che proprio il paziente vuole ed è in grado di perseguire, quest’ultimo coscientemente non si sente al sicuro, e prova ansia. Per questo motivo, molti colleghi, non solo giovani, credono che, per far sentire al sicuro il paziente, bisogni accettare o sostenere i suoi evitamenti. Ora, a me sembra del tutto evidente che questa strategia sia anti-terapeutica.Dal punto di vista della CMT, far sentire un paziente al sicuro vuol dire aiutarlo a esporsi al pericolo temuto facendogli vivere l’esperienza che quel pericolo non c’è più, oppure che ora può essere affrontato perché non è così grande come il paziente ha appreso che fosse. Vuole dire fargli fare l’esperienza, dentro e fuori la stanza di terapia, che la sua credenza patogena è falsa. Vuol dire aiutarlo a diventare consapevole della sua credenza patogena, delle sue origini, e del fatto che ora può sviluppare credenze diverse e più funzionali e scegliere queste ultime come guida del suo comportamento. E tutto questo è il contrario dell’evitamento.

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.

This paper aims to provide an overview of self-hate, a concept developed by control-mastery theory (CMT) to describe a set of pathogenic beliefs that share the common core of a deeply negative self-representation and self-evaluation, and that are often at the basis of severe personality pathology. Pathogenic beliefs that support self-hate are developed to adapt to early traumatic relationships that made the person feel unrecognized and unloved for who they are. These pathogenic beliefs make the person feel bad, inadequate, unworthy, and undeserving; in addition, empirical research has shown that they are often associated with relevant transdiagnostic psychopathological factors such as difficulties in mentalization, emotional dysregulation, low self-esteem, deep feelings of shame and guilt, depression, interpersonal problems, and a low level of personality functioning. During psychotherapy, patients with issues related to self-hate can be very challenging, and it can be difficult for therapists to develop a strong alliance with them. We will overview the principal manifestations of self-hate, the features of the traumas at its basis, the empirical research data collected on its psychopathological correlates, and their implications for treatment, stressing the importance of therapists’ attitudes and the centrality of corrective emotional experiences.

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

Introduction This study investigated the relationship between illness anxiety and interpersonal guilt as conceived in control-mastery theory. Additionally, we explored how illness anxiety symptoms relate to general anxiety, depression, alexithymia, autonomic nervous system reactivity, personality functioning impairment, sociodemographic factors, and childhood experiences. Methods A sample of 201 participants completed measures of illness anxiety (Health Anxiety Questionnaire), interpersonal guilt (Interpersonal Guilt Rating Scale-20s), anxiety (State-Trait Anxiety Inventory), depression (Beck Depression Inventory-II), alexithymia (Toronto Alexithymia Scale-20), personality dysfunction (Level of Personality Functioning-Brief Form 2.0), and autonomic nervous reactivity (Body Perception Questionnaire-22). Sociodemographic and childhood traumas and adverse experiences data were collected via an ad hoc questionnaire. Results Individuals with worried and autonomy-limiting caregivers reported higher levels of illness anxiety. Correlation analyses revealed significant positive associations with illness anxiety and all the variables measured. As expected, partial correlation demonstrated that separation/disloyalty guilt and burdening guilt are the most associated with illness anxiety symptoms. Unexpectedly, however, survivor guilt lost significance when controlling for other types of guilt. Hierarchical multiple regression identified anxiety as the strongest overall predictor of illness anxiety, followed by separation/disloyalty guilt and bodily reactivity indices. Discussion This study suggests that interpersonal guilt may be a key component in sustaining illness anxiety symptoms in anxious people. In particular, the interplay between anxiety, separation/disloyalty guilt, and autonomic overreactivity appears to contribute to illness anxiety concerns and behaviors. Working on these aspects may be essential for positive long-term outcomes of psychotherapy.

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.

Childhood emotional abuse is a recognized factor for long-term psychological and physical health problems, including persistent somatic symptoms. Negative self-beliefs, such as self-hate-related beliefs, may explain how emotional mistreatment contributes to physical distress in adulthood beyond general emotional difficulties. A longitudinal study was conducted with 298 help-seeking adults. At baseline, participants completed measures of childhood emotional abuse, self-hate, and general negative affectivity. Somatic symptoms were assessed two months later. Mediation analyses tested whether self-hate mediated the relationship between childhood emotional abuse and somatic symptoms while accounting for the influence of general negative affectivity, which reflects a general tendency to experience negative emotional states. Participants (Mage = 33.7, SD = 11.8) were predominantly female (63.3%) and Caucasian (84.2%). Childhood emotional abuse (M = 11.24, SD = 6.60) was significantly associated with self-hate (M = 10.35, SD = 6.13, r = 0.33, p

In queste poche pagine vorrei condividere con il lettore alcune osservazioni, fatte nel corso di più di dieci anni di pratica clinica e riflessione teorica nell’ottica della Control-Mastery Theory. Per chi lavora da questa prospettiva, la centralità del concetto di piano e della sua formulazione è ovvia: noi pensiamo che i pazienti vengano in terapia con un loro piano in gran parte inconscio, e che il compito del clinico è quello di comprendere questo piano, formularlo nel modo più preciso possibile dopo le prime due o tre sedute, e poi seguirlo.

Che cosa significa disconfermare una credenza patogena? Che cosa significa disconfermare una credenza patogena? Una delle espressioni più frequenti nella letteratura sulla Control-Mastery Theory è “disconfermare le credenze patogene del paziente”. Ma che cosa significa? Di primo acchito chiunque può pensare, e augurarsi, che disconfermare una credenza patogena voglia dire che quella credenza viene cancellata, non è più ritenuta vera dal paziente, viene lentamente messa da parte come un lontano ricordo. Ma, come sa chiunque lavori da un po’ di tempo e sia sufficientemente onesto con sé stesso, il caso di una credenza patogena che sia stata cancellata dalla psiche di un paziente o che sia stata resa inattiva in via definitiva è assolutamente raro, seppure sia mai stato registrato.

This study explored the relationship between different types of interpersonal guilt as conceived according to control-mastery theory and emotion dysregulation, mentalization, frustration intolerance, and body appreciation. We recruited 200 participants to whom we administered the Interpersonal Guilt Rating Scale-20, the Difficulties in Emotion Regulation Scale–Short Form, the Reflective Functioning Questionnaire-8, the Frustration Discomfort Scale, the Body Appreciation Scale-2, and a sociodemographic schedule. The data revealed that self-hate and burdening guilt were positively associated with emotion dysregulation and negatively associated with body appreciation. Frustration intolerance correlated with burdening guilt, while mentalization impairments were linked to self-hate. Both constructs also positively correlated with separation/disloyalty guilt. The findings of this study underline the association between several guilt-related pathogenic beliefs and relevant psychopathological factors such as emotional dysregulation, mentalization difficulties, frustration intolerance, and body dissatisfaction. Among the pathogenic beliefs investigated, a particular role is played by the belief that one is bad, inadequate, and undeserving; the belief that one’s own emotions, needs, and way of being is a burden to other people; and the beliefs that separating physically or psychologically from important others may hurt them. The clinical implications of these finds are discussed.

Nel corso degli ultimi anni mi sono imbattuto più volte in una situazione clinica che ha attirato la mia attenzione. Alcuni pazienti sembravano oscillare tra due posizione opposte ed entrambe dolorose: da una parte avevano la forte spinta a cercare di mettersi in evidenza per cercare di acquisire, per mezzo dei successi raggiunti e dell’ammirazione altrui, un senso del loro valore personale che interiormente sentivano essere scarso; dall’altra, ogni volta che la possibilità di mettersi in evidenza si concretizzava o che riuscivano a farlo, finivano per sviluppare stati di ansia o depressione piuttosto intensi subito prima, durante o dopo il loro successo. Dovevano “primeggiare” per sentire di avere un valore, ma al tempo stesso sentivano di “non meritare le luci della ribalta”.

Stimolata dalla visione di Parthenope, l’ultimo film di Sorrentino, e dalla lettura dello scritto Note cliniche sul “superamento” dell’odio di sé di Francesco Gazzillo, ho pensato potesse essere di una qualche utilità condividere un’ipotesi che mi torna in mente ogniqualvolta ho a che fare con pazienti con tematiche prevalenti legate al senso di colpa del sopravvissuto, a un certo punto della terapia. “Professoressa, non si sa molto della sua vita personale, perché non si è fatta una famiglia?” “Perché mi sono fatta le domande sbagliate”, risponde la protagonista del film di Sorrentino alle sue allieve, congedandosi dopo quarant’anni di carriera accademica in una delle scene finali del film. Ecco, le domande sbagliate.

Alla fine di una lunga terapia, un paziente con dinamiche predominanti da odio di sé, alla domanda relativa a cosa lo abbia aiutato di più del trattamento e cosa gli sia piaciuto di meno, mi risponde: “Come sa, io ho difficoltà con gli specchi, con la mia immagine allo specchio. Quando mi guardo, non mi piaccio, e per questo non mi riconosco mai del tutto. Ecco, credo che la cosa che mi è piaciuta di meno è che lei per me è stato spesso uno specchio impietoso. E credo anche che sia questa la cosa che mi è servita di più”.

The aim of this paper is to propose a psychodynamic hypothesis based on control-mastery theory (CMT) about the self-punishment function of some non-psychotic hypochondriacal states. After a review of several major psychoanalytic hypotheses about hypochondria, we will show the main concepts of CMT, an integrative, relational, cognitive-dynamic theory of mental functioning, psychopathology, and therapeutic process that is the theoretical framework that has helped us understand and treat these states in our patients. We will then describe two clinical cases to show how some hypochondriacal states can be interpreted as self-punishments connected to three main kinds of guilt hypothesized by CMT: survivor guilt, burdening guilt, and separation/disloyalty guilt. Finally, we will discuss the implications of these hypotheses.

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.

Il fenomeno clinico su cui vorremmo attirare la vostra attenzione, e che vorremmo approfondire con il tempo, potrebbe essere descritto così: ci sono alcune persone che frappongono tra sé e l’oggetto di cui si innamorano quella che vorremmo descrivere come una fantasia romantica relativa a sé, all’oggetto e alla relazione che deve esserci tra sé e l’oggetto. Questa fantasia si configura come uno o più scenari che permettono alla persona di vivere proprio le esperienze sentimentali che cerca per appagare i suoi bisogni amorosi e disconfermare le sue credenze patogene. Ma fino a qui non ci sono grandi differenze rispetto a ciò che a nostro parere accade in tutti gli innamoramenti.

Impostor phenomenon refers to the psychological feeling of intellectual phoniness. It can favor failures and support a scarce perception of one’s own competence in order to protect social relations. The aim of this study was to investigate, with a longitudinal design, the contribution of fear of success and guilt over success in the experience of impostor phenomenon and its connections to maladaptive behaviors, such as submission and self-handicapping tendency. We assumed that impostor phenomenon would mediate the relationship between fear of success, guilt over success, and distress related to it, on one hand, and self-handicapping and submissive behavior on the other. Moreover, several personality variables were tested as potential predictors and protection factors against impostor phenomenon. As expected, we found a positive relationship between fear of success, guilt over success, and impostor phenomenon, and a positive relationship between impostor phenomenon and a tendency toward submitting and self-handicapping. Our findings suggest that the tendency to experience guilt and distress about success and the preoccupation with the impact of one’s own success on our important relationship predicted, both directly and with the mediation of impostor phenomenon, the tendency to submit and self-handicap.

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.

Pathological narcissism is a personality constellation comprising distorted self‐image, maladaptive self‐esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control‐mastery theory (CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time‐limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism.

The aim of this paper is to present further data for the validation of the Interpersonal Guilt Rating Scale-15 self-report (IGRS-15s; Gazzillo et al., 2018). We recruited a sample of 448 subjects, to whom we administered the IGRS-15s together with other empirically validated measures for the assessment of social desirability, shame, self-esteem, empathy, mental health and therapeutic alliance. In line with our hypotheses, the previously established three-factor structure of the IGRS-15s (Survivor guilt, Omnipotence guilt, and Self-hate) was confirmed. Moreover, the internal consistency and test-retest reliability of IGRS-15s were adequate to good. All the IGRS-15s factors were negatively correlated with self-esteem and mental health and positively correlated with shame; Survivor guilt and Omnipotence guilt were positively correlated with empathy; Survivor guilt and Self-hate negatively affected therapeutic alliance; and different traumas had different, theoretically predictable, impacts on the different kinds of guilt. Overall, these data support the reliability and validity of the IGRS-15s.

The aim of this paper is to explore the theoretical and clinical features of burdening guilt according to control-mastery theory (CMT), an integrative, relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapy. CMT posits that burdening guilt stems from the belief that one’s emotions, needs, and way of being are a burden to significant others. After having introduced some research data about the belief of being a burden to others, we will point out how CMT explains this belief in light of a coherent theory of development, emphasizing its connection with early traumatic or adverse experiences with caregivers that give rise to the formation of pathogenic beliefs. These beliefs are mostly unconscious, and influence the way people make sense of themselves and their reality, giving rise to symptoms, inhibitions, and maladaptive personality traits that obstruct the achievement of healthy and adaptive goals. We will then compare burdening guilt with omnipotent responsibility guilt and self-hate, highlighting the points of contact and the differences between these types of interpersonal guilt. Subsequently, we will point out the “double nature” of burdening guilt, describing how it represents both a self-blame for what one is, and the expression of the need to take care of important others. Finally, we will propose a clinical vignette to illustrate some manifestations of burdening guilt in the therapeutic context.

Burdening guilt refers to the belief that one’s emotions, needs, and ways of being are a burden to others, and is one type of interpersonal guilt proposed by the control-mastery theory (CMT). The aim of this article is to validate two new measures of burdening guilt. In the two studies conducted, we examined the psychometric properties of these scales and the relationship between bur- dening guilt and self-perceived burden (burdensomeness), self-esteem, shame, anxiety, depression, mental health, attachment insecurity, adverse childhood experiences, social desirability, empathy, and suicidal ideation. In Study 1, we presented a newly developed Burdening Guilt Rating Scale (BGRS) and its correlation with measures of the abovementioned dimensions. In Study 2 we verified, through confirmatory factor analysis and correlation techniques, the possibility of expanding the Interpersonal Guilt Rating Scale-15 with a shorter, 5-item burdening guilt scale derived from the BGRS, and showed that this shorter scale correlates similarly to the longer one. Findings allowed us to validate these new scales providing empirical measures of burdening guilt—a theoretical concept with important clinical implications.

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.

According to Control-Mastery Theory (CMT)—a cognitive-dynamic relational theory of mental functioning, psychopathology, and psychotherapy—patients come to therapy with an unconscious plan to disprove their pathogenic beliefs and achieve adaptive goals. One of the primary ways patients work to disconfirm their pathogenic beliefs is by testing them within the therapeutic relationship. The present study aimed to replicate and expand the results of previous studies suggesting that therapists’ responses that disconfirmed patient’s pathogenic beliefs were predictive of patients’ within-session progress. Moreover, we wanted to investigate whether these interventions correlated with the therapeutic alliance. Transcriptions of 81 sessions from five brief psychodynamic psychotherapies were assessed by 11 independent raters. For each case, the patient’s plan was formulated and tests identified, the accuracy of the therapist’s responses to these tests was rated, and the impact of the therapist’s interventions on the patient’s subsequent communications and their relationship with the therapeutic alliance was measured. The results supported the central hypothesis of the CMT that when the therapist’s interventions passed the patient’s tests, the patient showed signs of improvement. Moreover, the ability of the therapist to pass the patient’s tests correlated with the therapeutic alliance. The clinical implications and the limitations of these findings are discussed, together with the relevance of a good case formulation for clinicians’ optimal responsiveness.

The plan formulation method (PFM) is an empirically validated procedure for identifying a patient's goals for therapy, what is hindering the patient from attaining those goals, and how the patient is likely to work in therapy. In this paper, we employ the PFM to analyze the initial psychotherapy sessions of Geena, a 30‐year‐old outpatient with borderline personality disorder and relational and substance abuse problems. Employing the PFM, we identify a family of pathogenic beliefs (e.g., that she is unlovable and unworthy; that her parents will be hurt if she has satisfying intimate relationships) that Geena sought to disprove in her therapy and explain how she worked with the therapist to do so. We illustrate how the PFM can help the therapist identify what information and what types of interventions will be helpful for a given patient.

Pathological narcissism is a personality constellation comprising distorted self-image, maladaptive self-esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control-mastery theory (CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time-limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism.

The aim of this article is to show how the plan formulation method (PFM), an empirically validated method for case formulation based on control mastery theory (CMT), can help clinicians make sense of and use what they feel during sessions to better understand and treat their patients. We give a brief overview of the main psychoanalytic conceptions about countertransference, provide a brief introduction to CMT, and describe the concept of the plan and the PFM. We then show, using several brief clinical examples, how the components of the plan (patient’s goals, pathogenic beliefs, traumas, tests, and insights) may help understand clinicians’ in-session feelings.

According to Control-Mastery Theory, an integrative cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapy process, functional psychopathology derives from pathogenic beliefs. Pathogenic beliefs associates a healthy and adaptive goal to a danger, are generally developed during the developmental period to adapt to traumas and are unconsciously tested by patients in psychotherapy to be disproved. We propose the existence of pathogenic beliefs that are mainly encoded as bodily tensions, sensations, emotions, intensions, mental images and expectations, and only secondarily or not at all as words. These non-verbal pathogenic beliefs painfully affect patients’ bodily states, emotions and behaviours without the patients being able to understand the reasons of their own sensations, reactions and actions. In order to dis- prove these non-verbal pathogenic beliefs in therapy, it is not enough that clinician help their patients make them explicit; clinicians have also to adapt their overall attitude, non-verbal and paraverbal communications, and to adjust the setting, the nuances and the “atmosphere” of the therapeutic relationship according to the specific developmental traumas that gave rise to these beliefs, the goals thwarted by them and to how the patient test them. The disconfirmation of pre-verbal pathogenic beliefs may also be facilitated by psychotherapy techniques that address the problems of patients on a bodily level. In order to disprove preverbal pathogenic beliefs, an embodied corrective emotional experience is needed.

The aim of this article is to empirically investigate the relationships among interpersonal guilt, as conceived within control-mastery theory (CMT), and attachment, altruism, and personality pathology in an English-speaking sample. An online sample of 393 participants was recruited to complete the Interpersonal Guilt Rating Scale self-report version-15 (IGRS-15s), together with other empirically validated measures for the assessment of attachment, altruism, and personality pathology. On the basis of previous studies conducted in Italian-speaking samples, we hypothesized that survivor guilt, separation/disloyalty guilt, and omnipotent responsibility guilt would be associated with attachment anxiety and avoidance, altruism, and personality pathology; self-hate was hypothesized to be associated only with attachment anxiety and avoidance and personality pathology. Analyses examined bivariate associations as well as the network of partial correlations among variables. The results largely confirmed hypothesized associations, with self-hate evincing the strongest unique association with personality dysfunction. Findings provide a basis for further research regarding interpersonal guilt and personality and relational functioning, with potential implications for clinical conceptualizations of the role of guilt in psychopathology.

Psychotherapists can experience various kinds of emotions in response to their patients’ communications and behaviors over the course of therapy. These may be understood in the context of interpersonal dynamics associated with patients’ testing activity. The concept of testing, as part of the patient’s plan for therapy, is explained from the perspective of Control-Mastery Theory. Different kinds of testing behaviors, aimed at disconfirming the patient’s pathogenic beliefs, may evoke different emotions in the therapist. Understanding the patient’s testing strategies can help to make sense of the therapist’s emotional reactions, manage countertransference, and guide therapeutic responses. This paper describes testing behaviors, according to the patient’s compliance and non-compliance with pathogenic beliefs, along with corresponding therapist emotional responses. A descriptive clinical case is provided to illustrate various tests and their associated emotional reactions within a therapy session.

The aim of this paper is to empirically assess the reliability of the plan formulation method for couples, a procedure for formulating the case, planning, and monitoring the couple therapies according to control-mastery theory. We hypothesized that when couples are looking for couple therapy, they have an unconscious couple’s plan for the therapy, which includes the couple’s goals; the pathogenic beliefs that the partners want to disprove; the traumas from which these beliefs originated and that the partners want to master; the vicious relational circles that make the couple suffer and that the couple wants to break; the virtuous relational circles that are expressions of the couple’s resources and that the couple wants to fuel; and the relational insights that may help the couple get better. Our study involved 15 couples treated by four experienced therapists. Four raters independently formulated each couple’s plan based on the first three sessions following a standard procedure, and we calculated the intraclass correlation for pooled judges’ ratings. For a subsample of three couples—who before and after treatment had completed the dyadic adjustment scale (DAS) and the outcome questionnaire-45.2 (OQ-45.2)—the compatibility of the therapists’ interventions with the couples’ and partners’ plans was assessed. The relationship between the ratings of compatibility, DAS and OQ-45.2, was assessed. The results showed excellent interjudge reliability for each couple’s plan formulation (average ICC=0.82), attesting to the validity of the procedure; and preliminary data on the therapeutic process suggested that therapists’ interventions compatible with couple’s plans could help partners achieve good outcomes.

The aim of this paper is to show the evolution of the psychoanalytic conception of fantasy/phantasy from a psychic activity aimed at denying reality and/or fulfilling frustrated wishes to a tool useful for adapting to reality. We will then review some recent findings of empirical research on imagination and mental simulation showing how these activities, and mind wandering in general, is expression of the constant effort of the psyche to set and pursue adaptive goals, to elaborate and test plans, and to master and solve problems and traumas. Finally, we will show how these empirical data are consistent with the conception of fantasy proposed by the control-mastery theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993), an integrated cognitive-dynamic relational theory of psychic functioning, psychopathology, and psychotherapy developed and tested in the last 40 years by the San Francisco Psychotherapy Research Group.

The aim of this paper is to give the reader an overview of several theoretical, empirical, and clinical features of survivor guilt, and to integrate recent contributions of psychodynamic theory and, in particular, of control-mastery theory into the understanding of the concept alongside the latest findings in social psychology about it. After introducing the concept of survivor guilt and its origins in clinical observations on the consequences of having survived severe traumas (e.g., internment in concentration camps), we will discuss the findings in social psychology on the concept of survivor guilt in everyday social interactions, which is based on a conception that does not connect it strictly to severe traumas. We will then focus our attention on clinical observations and empirical research studies about survivor guilt, discussing the hypotheses developed by several control-mastery theorists about its role in psychopathology. Finally, we will illustrate some manifestations of survivor guilt with a brief clinical vignette.

The aim of this paper is to show how the Plan Formulation Method, an empirically validated and clinically useful assessment procedure, can be adapted to the therapy of adolescents. According to Control-Mastery Theory, patients come to therapy with an unconscious plan to achieve their goals, disconfirm their pathogenic beliefs, and master their traumas. PFM is a procedure aimed at formulating the unconscious plan of a patient with high levels of reliability and it articulates this plan in five components: the goals that the patient wants to achieve, the obstructions to these goals, the traumas which have given rise to these obstructions, the way the patient will try to overcome these obstructions during the therapy (tests), and the insights that the patient needs to achieve in order to get better. To apply this method to adolescent therapy, we added two components: the vicious relational circles between adolescents and their relevant others which support the patient’s problems and that the patient wants to break, and the experience the adolescent needs in order to get better. Each component will be explained with the help of a clinical case. The possible applications of the PFM to adolescents both in clinical and research contexts will be discussed.

This paper aims to emphasize the fundamental role of unconscious processes in our adaptation. We will point out how we are able to unconsciously perform higher mental functions such as setting goals and planning how to pursue them, dealing with complex data, and making choices and judgments. In the first part of this paper, we will describe the main features of conscious and unconscious processes as pointed out by recent empirical research studies, and we will see how safety is essential in pursuing our fundamental goals, and how unconscious mental processes are strongly oriented towards preserving our safety and pursuing these goals. Finally, we will discuss control-mastery theory (CMT), an integrative, relational, cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapy processes developed by Joseph Weiss and empirically validated by Weiss, Harold Sampson, and the San Francisco Psychotherapy Research Group over the last 50 years. This conceptualizes unconscious processes starting from this “higher unconscious mental functioning” paradigm and, in accordance with research data, stresses that our main goal is to adapt to reality and pursue adaptive developmental goals while preserving our safety. Three clinical vignettes will help show how the concepts proposed by CMT have important implications for therapeutic process.

Impostor phenomenon (Clance, 1985) refers to the psychological experience of individuals who perceive themselves as intellectual frauds and fear of being exposed as impostors. Previous studies suggest that the fear of failure, the fear of success, and low self-esteem are preconditions that foster the occurrence of impostor feelings (e.g., Neureiter & Traut-Mattausch, 2016). The aim of this study was to investigate the relationship between the impostor phenomenon and interpersonal guilt as conceived in Control-Mastery Theory (Faccini et al., 2020), and their association with anxiety and depression. 343 subjects completed the Interpersonal Guilt Rating Scale-15s (IGRS-15s; Faccini et al, 2020), the Clance Impostor Phenomenon Scale (CIPS; Clance, 1985), the State-Trait Anxiety Inventory (STAI; Spielberger et al., 1983), and the Beck Depression Inventory II (BDI II; Beck et al., 1996). As expected, impostor phenomenon was significantly associated with self-hate, survivor guilt and omnipotence guilt. The hypothesis that these kinds of guilt and the impostor phenomenon can contribute to anxiety and depression has also been confirmed. This study suggests that people who experience impostor fears struggle with maladaptive feelings of guilt related to pathogenic beliefs about oneself and significant others, favoring depression and anxiety. Therefore, working on these aspects can be essential in treating these patients.

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.

Termination processes in psychotherapy vary widely across patients, therapists, and therapies. While general guidelines on termination can inform ethical and responsible termination practices, termination decisions and processes are likely optimized using a case-specific approach. Control-mastery theory (CMT) provides a framework for considering the unique ways individual patients work in psychotherapy and can be applied to help therapists understand and facilitate optimal terminations. The present article provides a brief overview of CMT and outlines perspectives regarding the decision-making and discussion of psychotherapy termination, the processing of termination, and the final session of therapy. Question: How can psychotherapy termination be considered and responded to in a case-specific, personalized way? Findings: Control-mastery theory provides a framework for considering the patient’s adaptive goals, pathogenic beliefs, traumas, and tests in determining individualized clinical responses to termination-related issues in psychotherapy. Meaning: Clinicians can help patients disconfirm pathogenic beliefs—through passing their tests—throughout the termination process, including during the final psychotherapy session. Next Steps: Further research is needed to understand patients’ testing strategies specifically in the context of psychotherapy termination.

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.

A good enough theory of psychological functioning and development, and of how psychotherapy works, should take into account recent scientific developments about emotional, motivational, and cognitive functioning. They show how human beings are “wired” to adapt to reality and share a set of evolutionary-based emotions, motivations and skills that are shaped by the cognitive-affective structures (schemas) developed on the basis of the emotionally relevant experiences, in particular of the first years of life. Attachment theory (Bowlby, 1969, 1973, 1980) represents the first real attempt in this direction, although the clinical implications of this theory are still fragmented and not specific enough. We think that control mastery theory (CMT; Weiss, 1993) could be useful for integrating attachment, psychodynamic, and cognitive-evolutionary thinking. Such an integrated model is based on the centrality of adaptation, sense of safety, and real experiences; on the central role of inner representations/beliefs/schemas in linking adverse developmental experiences and attentional strategies, perception organization, emotional reactions, behavior, and psychopathology; and on the necessity to modify this relational knowledge in order to help patients get better. To explore the possible integration between attachment theory and CMT, we will focus on a specific topic, the disorganization of attachment and its psychopathological consequences, and we will illustrate the implications of this integration with a brief clinical example. We chose to focus on attachment disorganization because it is the attachment category more consistently related to psychopathology.

aim of this article is to propose an interpretation of pathological worry and rumination based on the control-mastery theory (CMT), an integrative, relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapy process developed by Joseph Weiss and empirically verified by Weiss, Harold Sampson, and the San Francisco Psychotherapy Research Group over the last 50 years. In the first part of this article, we will introduce the basic concepts of CMT and how this theory integrates dynamic and cognitive concepts into a relational theoretical frame. Then, we will review several definitions of pathological worry and rumination and their clinical features and consequences. We will differentiate these processes from the normal reflection processes aimed at solving problems and mastering traumas and will review research data supporting this differentiation. Finally, we will discuss some of the more important cognitive theoretical models for explaining pathological worry and rumination. In the last part of this article, we will describe how CMT can help understand pathological worries and ruminations and their functions. According to CMT, pathological worry and rumination are distortions of normal reflexive thinking often caused by pathogenic beliefs that support interpersonal guilt, and their unconscious aim is often self-punishment. Three clinical vignettes will help us show how CMT can help us understand and treat pathological worry and ruminations.

The aim of this paper is to illustrate the meaning and functions of dreams according to control-mastery theory (CMT), a cognitive-dynamic relational theory developed and empirically validated in the last 40 years by the San Francisco Psychotherapy Research Group (Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993a; Weiss, Sampson, & the Mount Zion Psychotherapy Research Group, 1986). CMT stresses how dreams reflect the person’s efforts to adapt to reality; their production is regulated by a safety principle and is an expression of human unconscious higher adaptive functions. According to this model, dreams represent our unconscious attempts to find solutions to emotionally relevant problems. In dreams people think about their main concerns, particularly those concerns that they have been unable to solve by conscious thought alone, and they try to develop and test plans and policies for dealing with them. After having introduced the reader to the main concepts of CMT, we will illustrate the different facets of the CMT model of dreams with several clinical examples. Finally, we will describe the core elements of recently developed models of dream functions and meanings based on empirical research on sleep and dreams, and we will show their substantial compatibility with hypotheses proposed by CMT.

This article proposes an adaptation to couple therapy of the Plan Formulation Method, an empirically validated and clinically useful assessment procedure for planning case-specific psychotherapy interventions. According to Control-Mastery Theory (CMT), individuals who seek psychotherapy have an unconscious plan, which comprises goals, obstructions, tests, traumas, and insights. The Plan Formulation Method was developed to reliably formulate individual psychotherapy cases. To apply this method to couples therapy, we have added two components: dysfunctional relationship patterns (vicious relational circles) and resources (virtuous relational circles). Each component will be explained with the help of a clinical case. We discuss the implication of the use of the Plan Formulation Method for couples and compare some of the tenets of CMT applied to couples with the main approaches to couple therapy.

The aim of this article is to present an overview of several recently proposed hypotheses about the development of morality and guilt during the evolution of our species and the individual psychic development. The article will show how group selection seems to have favored the development of prosocial motivations, emotions, and skills, which are the basis of “moral” judgments and behaviors, and how the specific experiences of each individual and her/his belonging to a specific culture shape this first moral innate “draft.” We will then review relevant empirical data about the development of guilt in infancy and early childhood from empathic concern and the tendency to feel responsible for other people’s wellbeing, and the temperamental and environmental factors at the basis of adaptive and maladaptive guilt. Finally, we will show the substantial compatibility between these recently developed hypotheses and data and the hypotheses developed by the Control-Mastery theory starting from clinical observation and from the ideas of several psychoanalytic authors.

Worry and rumination are maladaptive cognitive strategies with the purpose to manage negative emotions and threatening events (Wells & Matthews, 1994), and studies have shown that they are associated with an increasing of anxiety and depression (Fresco et al., 2002; Nolen-Hoeksema, 2000). Although the relationship between guilt and shame with depression and anxiety is well documented (Cândea & Szentagotai-Tătar, 2018; Thibodeau, & Jorgensen, 2011), only few studies (Orth et al., 2006; Mor & Winquist, 2002; Spasojevic & Alloy, 2001) investigated the mediational role of worry and rumination in the relationship between guilt and shame and depression and anxiety. We hypothesized that worry and rumination correlate with all types of interpersonal guilt and with shame and that they mediate the effects of these moral emotions on depression and anxiety disorders. We recruited a sample of 343 subjects, to whom we administered the Interpersonal Guilt Rating Scale-15s (IGRS-15s; Gazzillo et al. 2018), The Other as Shamer Scale (OAS; Goss, Gilbert, & Allan, 1994), The State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983), The Beck Depression Inventory II, The Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990) and The Ruminative Response Scale (RRS; Nolen-Hoeksema & Morrow, 1991; Treynor et al., 2003) and an ad hoc form for assessing sociodemographic and anamnestic information. In line with our hypotheses (Gazzillo, Leonardi, Bush, 2020), worry and rumination correlated with all types of interpersonal guilt. Moreover, worry and rumination were positively correlated with depression and anxiety disorders; specifically, rumination emerged as a mediating factor between self-hate and depression, while worry was a mediating factor in the relationship between omnipotence and trait anxiety. Finally, our hypothesis that, in worrying and ruminating, shame had a relevant impact, was also confirmed. This study suggests that guilt and shame may be a powerful component of mental health problems and that worry and rumination represent risk factors for the maintenance and exacerbation of these disorders.

The aim of this paper is to present further data for the validation of the Interpersonal Guilt Rating Scale-15 self-report (IGRS-15s; Gazzillo et al., 2018). We recruited a sample of 448 subjects, to whom we administered the IGRS-15s together with other empirically validated measures for the assessment of social desirability, shame, self-esteem, empathy, mental health and therapeutic alliance. In line with our hypotheses, the previously established three-factor structure of the IGRS-15s (Survivor guilt, Omnipotence guilt, and Self-hate) was confirmed. Moreover, the internal consistency and test-retest reliability of IGRS-15s were adequate to good. All the IGRS-15s factors were negatively correlated with self-esteem and mental health and positively correlated with shame; Survivor guilt and Omnipotence guilt were positively correlated with empathy; Survivor guilt and Self-hate negatively affected therapeutic alliance; and different traumas had different, theoretically predictable, impacts on the different kinds of guilt. Overall, these data support the reliability and validity of the IGRS-15s.

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.

Most patients present with a combination of symptoms and relational problems, but often psychotherapies are not conducted in a way to deal with both. Many therapists take a top-down approach to treatments. That is, the techniques they use are based on their theories of therapy (that suggest how certain diagnoses should be treated) rather than on an understanding of the unique problems and issues of the individual patient. We suggest that what is needed is a bottom-up approach , in which the individual patient’s goals, conflicts, inhibitions, and so forth are identified and therapeutic interventions are designed accordingly on a case-specific basis. The foundation of such an approach is a case-specific clinical formulation. There are a number of formulation methods; we focus on the plan formulation method to illustrate how to evaluate the individual needs and specificities of the therapy patient and then how to tailor a therapy to the individual patient, regardless of the therapist’s theoretical or technical predilections. Finally, we report examples of therapies conducted in this bottom-up approach to demonstrate how symptoms and relational problems can and should be addressed.

The aim of this paper is to present a theoretical and empirical overview of the hypothesis that patients’ behavior in psychotherapy can be understood as an expression of their efforts to disprove their pathogenic beliefs by testing them in the therapeutic relationship. According to Control–Mastery Theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1986, 1994), psychopathology stems from unconscious pathogenic beliefs developed in response to early traumas. Pathogenic beliefs associate the achievement of healthy goals with a variety of unconsciously perceived dangers. Thanks to the inborn human motivation to adapt to reality and to the power of adaptive unconscious mental functioning, patients come to therapy with a unconscious plan to overcome their pathogenic beliefs by testing them with their therapists. Tests are consciously or unconsciously devised actions aimed at disproving pathogenic beliefs. CMT describes two broad categories of tests: transference tests and passive-into-active tests. Tests require specific responses from the therapist to be passed. When therapists pass patients’ tests, patients feel safer and may make therapeutic progress; when tests are failed, patients feel endangered and may get worse. Consistent with CMT assumptions, studies on testing have shown that a therapist passing a patient’s tests is associated with immediate positive effects on the patient, but more studies are needed.

The aim of this paper is to describe and discuss the models of the process of change in psychotherapy developed by the Boston Change Process Study Group (2010), and by the San Francisco Psychotherapy Research Group (Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993; Weiss, Sampson, & the Mount Zion Psychotherapy Research Group, 1986). The first model is centered on change in implicit relational knowledge and describes the process of change as being composed of “moving along” phases interspersed by “now moments” that can become “moments of meeting” if the clinician is to give authentic and specifically fitted responses. A moment of meeting opens up space for a change in the implicit relational knowledge of the patient. The second model is centered on the idea that patients come to therapy with an unconscious plan to master traumas, pursue healthy and adaptive goals, and disprove their pathogenic beliefs, and points to how patients test their pathogenic beliefs in the relationship with the therapist, coaching the therapist about what they need. Passing patients’ tests means helping them disconfirm or undermine pathogenic beliefs that hopefully will lead to disproving them. This second model focuses on the subjective meaning of the therapeutic process as seen from the perspective of the patient. We will also try to show, using clinical examples, how these two models can be integrated and how their integration may give us a more comprehensive, tridimensional vision of the therapeutic process.

Questo breve scritto nasce da alcune riflessioni che mi sono state suscitate dalle difficoltà che colleghi, giovani e non, incontrano nel condurre i primi colloqui in ottica Control-Mastery Theory (CMT). In linea del tutto generale, è mia impressione che queste difficoltà nascano da due atteggiamenti opposti: alcuni colleghi conducono i primi colloqui con uno schema di domande relativamente rigido, come se l’essenza del colloquio fossero le domande da porre al paziente, in una sorta di emulazione di un colloquio anamnestico-psichiatrico male applicato. Viceversa, altri sembrano abbandonarsi totalmente ai racconti o ai silenzi dei pazienti, senza sapere bene cosa fare o dove andare a parare, chiedendo al massimo ai pazienti cosa stiano pensando o facendo interventi tesi a “validarli”. E in entrambi i casi restano con la sensazione, ben percepibile anche a un supervisore, di non aver capito gran che del paziente. O con ipotesi che a un ascolto un po’ più attento sembra non abbiano molto a che fare con il paziente, mentre riflettono chiaramente i temi del terapeuta o il suo modello teorico di riferimento.

Recent studies on moral development suggest the existence of a set of innate abilities which foster moral functioning. From a very early age on, children seem to show ability for moral discernment, together with emotions and pro-social motivations based on an innate propensity to empathize with people in difficulty and respect equity; moreover, they tend to feel guilty when they believe that they transgressed some basic “moral principles”. Evolutionary studies suggest that human morality stems from group selection. During its evolutionary history, human species met socioecological conditions that made group selection the dominant evolutionary force, thus favouring the development of cognitive abilities, emotions, and motivations essential for cooperation within groups. Also according to the CMT morality arises from the human need to preserve connectedness with other people - family members above all (attachment) - and the propensity to make them feel good (care). In sum, starting from an innate moral draft which is pre-reflexive and evolutionarily founded, morality and guilt would then be shaped by the emotionally relevant experiences people go through within their family and cultural environment.

This article introduces the Interpersonal Guilt Rating Scale-15 (IGRS- 15), a brief clinician-rated tool for the clinical assessment of interpersonal guilt as conceived in Control-Mastery Theory (CMT; Silberschatz, 2015; Weiss, 1993), and its psychometric proprieties. The items of the IGRS-15 were derived from the CMT clinical and empirical literature about guilt, and from the authors’ clinical experiences. Twenty-eight clinicians assessed 154 patients with the IGRS-15, the patient self-reported Interpersonal Guilt Questionnaire-67 (IGQ- 67; O’Connor, Berry, Weiss, Bush, & Sampson, 1997), and the Clinical Data Form (CDF; Westen & Shedler, 1999). A semi-exploratory factor analysis pointed to a four-factor solution in line with the kinds of guilt described in CMT: Survivor guilt, Separation/disloyalty guilt, Omnipotent responsibility guilt, and Self-hate. The test-retest reliability of the IGRS-15 was good. Moreover, the IGRS-15 showed good concurrent and discriminant validity with the IGQ-67. IGRS-15 represents a first step in the direction of supporting the clinical judg- ment about interpersonal guilt with an empirically sound and easy-to-use tool.

Control-Mastery Theory (CMT) is a cognitive-psychodynamic-relational theory of mental functioning, psychopathology and psychotherapy developed by Joseph Weiss (1993) and empirically studied by the San Francisco Psychotherapy Research Group (Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986). The central hypotheses of CMT are: the humans being's motivation to adapt to reality, their unconscious ability to execute higher mental functions and the importance of pro-social motivations and interpersonal guilt in normal and pathological mental functioning. The aim of this paper is to provide a review of the most important neuroscientific studies, along with both evolutionary and cognitive psychology researches that support these hypotheses. These studies showed how the evolution of species have been producing a series of behavioral systems, evolutionary based but “environmentally labile” which, overall, have promoted individuals and groups' survival and reproduction. To adapt to our own primary group, each of us builds a reliable set of beliefs about our surrounding world and about “moral rules” that govern relationships. Psychopathology can be seen as the expression of beliefs that had facilitated the adaptation of the child to a traumatic environment but have then revealed to be maladaptive because of the changing circumstances.

The aim of this article is to present validation data about a self-report rating scale for the assessment of interpersonal guilt according to Control-Mastery Theory (CMT; Silbershatz, 2005; Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986), the Interpersonal Guilt Rating Scale-15s (IGRS-15s). In order to perform the validation of this tool in an Italian sample we have collected a sample of 645 nonclinical subjects. They had to complete the IGRS-15s, the Scale for the Measurement of the Impending Punishment (SMIP; Caprara et al., 1990), the Interpersonal Guilt Questionnaire-67 (IGQ-67; O'Connor et al., 1997), the Psychological General Well-Being Index (PGWBI; Dupuy, 1984), and the Affective Neuroscience Personality Scales (ANPS; Davis, Panksepp, & Normansell, 2003), together with an ad-hoc questionnaire for collecting demographic data, the Socio-Demographical Schedule. We have performed a confirmatory factor analysis to verify if the four-factor solution based on CMT and replicated in previous research (Gazzillo et al., 2017) was confirmed. Then, we checked the retest reliability of IGRS-15s after four weeks in a random subsample of 54 subjects. In order to assess its concurrent and discriminant validity, we calculated the correlations between IGRS-15s assessment and SMIP and IGQ-67. Finally, to test its construct validity, we assessed the relationships between the IGRS-15s and the affective systems using the ANPS and the wellbeing assessed with the PGWBI. The data collected support the retest reliability and the concurrent and discriminant validity of the measure, and we have collected preliminary data about its construct validity. Examples of the possible clinical and research applications of this tool are discussed.

La Control-Mastery Theory (CMT) è una teoria psicodinamica-cognitiva di matrice relazionale del funzionamento mentale, della psicopatologia e della psicoterapia sviluppata da Joseph Weiss (1993) e studiata empiricamente dal San Francisco Psychotherapy Research Group (Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986). Tra le ipotesi centrali della CMT vi sono la centralità della motivazione all'adattamento alla realtà, l’idea che siamo in grado di compiere inconsciamente operazioni mentali superiori e il ruolo di rilievo attribuito alle motivazioni prosociali e ai sensi di colpa interpersonali nel funzionamento normale e patologico. Scopo di questo lavoro è fornire una rassegna di alcuni dei principali studi neuroscientifici, di psicologia evoluzionista e di matrice cognitivista a sostegno di queste ipotesi. Gli studi considerati mostrano come l’evoluzione della specie abbia prodotto una serie di sistemi comportamentali evolutivamente fondati, ma “ambientalmente labili”, che nel loro complesso promuovono la sopravvivenza e la riproduzione dell’individuo e dei gruppi. Per adattarsi al proprio gruppo primario, ognuno di noi costruisce una serie di credenze affidabili sul proprio mondo circostante e sulle norme “morali” che regolano le interazioni. La psicopatologia può essere letta come l’espressione di credenze che hanno favorito l’adattamento del bambino ad ambienti traumatici ma si sono rivelate disadattive al mutare delle circostanze.