Articoli Scientifici

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.

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.

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.

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.

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.

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.

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.

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.

Come acutamente osservato da George Silberschatz (2016) in un’intervista che si trova sul nostro sito, a volte diamo per scontato che una nostra risposta sia un modo per superare un test, o costituisca un intervento pro-plan, perché è in questo modo e con questo senso che l’abbiamo pensato. E viste dalla prospettiva di un osservatore terzo, le cose stanno realmente così. Ma non è detto che tutti i pazienti “traducano” come ci attendiamo la risposta o l’intervento del terapeuta; anzi, un intervento in buona parte pro-plan o un test apparentemente superato può essere “tradotto” dal paziente come anti-plan o come un test fallito. E credo che i fattori alla base di questi fraintendimenti siano l’intensità con cui un paziente presta fede alle sue credenze patogene e dei sentimenti che a esse si associano.

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.