Articoli Scientifici

Il contributo propone una riflessione clinica sulle difficoltà sentimentali e sulle dinamiche di dipendenza affettiva osservate in giovani donne cresciute come figlie uniche con madri single. Attraverso il confronto tra esperienze cliniche, il lavoro approfondisce il ruolo della qualità dei legami familiari, della concentrazione delle funzioni affettive e identitarie nella relazione materna e delle credenze patogene che possono influenzare le relazioni sentimentali. In una prospettiva ispirata alla Control-Mastery Theory, viene sottolineata l'importanza dei primi colloqui per comprendere il piano inconscio del paziente e orientare il percorso terapeutico.

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.

L’obiettivo di questo scritto è di illustrare le potenzialità terapeutiche del gruppo alla luce dell’impianto teorico della Control-Mastery Theory, descrivendone le fasi cruciali: la fondazione e l’avvio di un gruppo terapeutico. Si introdurranno inoltre ipotesi e modalità di verifica (mappa del gruppo) legate alla configurazione del piano inconscio individuale all’interno di una dimensione gruppale. La Control-Mastery Theory offre una cornice utile per comprendere ciò che rende un’esperienza terapeutica trasformativa. I suoi fattori terapeutici principali riguardano, da un lato, la possibilità per il paziente di vivere un’esperienza emotivamente correttiva mettendo alla prova—attraverso i test—le proprie credenze patogene e osservandone la disconferma; dall’altro, l’insight, che consente di ricollegare tali vissuti alla propria storia personale, riorganizzandone il significato (Gazzillo, 2021). Perché questo processo possa attivarsi, è fondamentale che la persona percepisca un sufficiente senso di sicurezza, condizione che le permette di ricominciare a lavorare per perseguire i propri obiettivi riducendo l’impatto delle credenze patogene. Partendo da questi presupposti, possiamo chiederci in che modo il lavoro di un paziente all’interno di un gruppo terapeutico possa favorire esperienze emotive correttive. La presenza di molti membri, ognuno con il proprio modo di comunicare e di entrare in relazione, crea un contesto ricco e plurale. Tuttavia, tale pluralità porta con sé delle inevitibili crisi relazionali, un po’ come è stato già osservato all’interno di un contesto di terapia di coppia o familiare (Crisafulli, Rodomonti, 2018). Nella rete di relazioni che andrebbe a generarsi dall’istituzione del gruppo, troviamo che il ruolo della conduzione – in un’ottica di mediazione, contenimento e comprensione dei test relazionali che i pazienti mettono in campo – risulterebbe fondamentale per raggiungere gli insight e gli obiettivi desiderati da ciascuno.

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.

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.