The Application of Control Mastery Theory&cr;and Techniques to Educational Therapy

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This article is intended to present a particular theory of psychotherapy known as Control-Mastery theory, which has been empirically researched since 1972 at the San Francisco Psychotherapy Research Group in San Francisco.

It provides a systematic approach to psychotherapy but can be helpful to educational therapists who encounter children and families with psychological as well as educational difficulties. This theory can be particularly useful: (1) in understanding why some children do not make expected educational progressin spite of a good remedial program and an accurate diagnostic evaluation; (2) in those instances when the dynamics between a parent and a child interrupt remediation; and (3) when the educational therapist is feeling particularly discouraged. Control-Mastery theory provides a framework for understanding psychological information gathered in a learning disability evaluation which will include parent and child interviews, test data and observations, and comments from the teacher. This framework can assist the educational therapist not only in being more effective when dealing directly with children, parents and teachers, but also when making referrals for child psychotherapy, parent guidance, family therapy, or individual psychotherapy for a parent. Control-Mastery theory is straightforward, has broad appeal, and fits so well with a neurological or educational framework that it can enrich an educational therapy practice without expecting the educational therapist to go beyond the scope of training or become a clinical psychologist or psychiatrist.

School underachievement and learning disabilities put children at risk for future psychopathology, unemployment, and failure at independent living (Sikorski, 1996). Learning disabilities alone are considered to be a psychiatric category listed in The Diagnostic and Statistical Manual IV (American Psychiatric Association, 1994); neuropsychological deficits are considered to be an area of psychological vulnerability (Levi, G., M.D., et al, 1994); but in spite of the risks of not doing so, dealing with emotions has been considered to be outside the scope of the classroom teacher and, to some extent, the learning specialist. The therapeutic value of remediation should not be minimized; and by attending to feelings in the classroom and in remedial work, the educational therapist can help the child make better use of the educational process. Specialists of all kinds can help children meet individual goals and to become fully functioning at school and at home. Success in one area can impact on all the others. Joseph Weiss, M.D., and Hal Sampson, Ph.D., began to collaborate in 1964 and founded the Mount Zion Psychotherapy Research Group in 1972 (now known as the San Francisco Psychotherapy Research Group, or SFPRG). The purpose of the SFPRG is to formally research the validity of Dr. Weiss's concepts as described by Control-Mastery theory.

A concise definition of Control-Mastery theory is that psychopathology stems from unconscious pathogenic beliefs that the patient acquires from early traumatic experiences. Psychopathology refers to symptoms that an individual develops such as depression, anxiety, or habitual patterns of behavior that interfere with personal, interpersonal, educational, or occupational functioning. Pathogenic beliefs refer to the irrational ideas one develops about oneself or others as a result of traumas or stressors experienced in childhood. For example, if a child has an argument with a parent because the child wants to ride her bicycle to a friendís house; then, subsequent to the argument, the parent dies in an automobile accident, the child, being naturally egocentric, could decide that it was her anger that caused the death of her parent. She may develop the irrational idea that to explore, i.e., ride her bicycle, and socialize, i.e., visit her friend, are dangerous activities. Without help, this child could become an adult who is reclusive, afraid to express anger or travel. The patient suffers unconsciously from these beliefs and the feelings of guilt, shame, and remorse that they engender. The individual is powerfully motivated unconsciously to change those pathogenic beliefs and feelings. The patient exerts considerable control over the unconscious mental life, and makes and carries out plans for working with the therapist to change the pathogenic beliefs. Dr. Weissí case-specific approach and observations challenge several therapeutic dichotomies about psychotherapy being either supportive or uncovering; interactive or interpretive; relational or analytic. Most of Dr. Weissí theories, processes and techniques are well suited for use by educational therapists. (For in-depth information regarding this theory and unconscious processing, the reader is referred to Weiss, 1993.)

Control-Mastery Theory This paper focuses on four of the central points of Control-Mastery theory because they can be most useful to educational therapists. Excluded here are aspects of the theory related to transference, counter-transference, and dreams. The title of the theory essentially summarizes the theory. Control: As stated in the title of the theory, control means that individuals have some measure of control over their own unconscious mental functioning. Individuals can think, make inferences, test reality, make and carry out decisions and plans, both consciously and unconsciously. The individual regulates the unconscious mental life in accordance with an assessment of the environment. The individual seeks safety and avoids danger. This idea that individuals think and plan unconsciously, as well as consciously, is of major significance to the educational therapist because remediation can no longer be seen as working only with the conscious mind. Mastery: Individuals want to overcome traumatic childhood experiences and achieve healthy desirable goals. This assumption shifts the specialistís view, and subsequent attitude, away from seeing certain behaviors as resistance and toward a therapeutic stance which is open to a variety of possible reasons for a childís difficulties or unwillingness to attempt the work. Control-Mastery theory is a case-specific approach. The therapist seeks to provide a safe environment and formulate a treatment plan.

Four Central Points The four central assumptions of Control-Mastery theory to be presented here are: (1) pathogenic beliefs; (2) motivation; (3) the principal of safety; and (4) testing, which includes transference testing and passive-into-active testing.

Pathogenic Beliefs: In this theory, psychopathology is a result of pathogenic beliefs, e.g., illogical, inaccurate ideas about oneself and others that develop as a result of childhood stressors and traumas. For example, I treated a young man who took a year off from college because he had failed a qualifying examination in his major which involved playing his musical instrument solo in front of a jury. If he failed it again, he would not be able to graduate in his chosen field. What emerged was that his failure was not the result of his diagnosed learning disability and attention-deficit disorder, for which he was taking Ritalin, but the residual impact of having had such a diagnosis. The belief he developed about himself, and his compliance with his mother, who described herself as ìthe mother of a severely handicapped child,î was what maintained his difficulty and prevented him from using what he had learned in years of remediation. This young man wanted to relinquish his old diagnostic label, permit himself to succeed at something he enjoyed, and de-authorize his mother from her chosen job as the mother of a severely handicapped child. He worried about hurting his mother and separating from her. After a year of psychotherapy and a change in medication, he returned to college and sailed through his exam.

Children develop pathogenic beliefs because they are both naturally empathic and naturally egocentric. Children tend to feel responsible for what happens to them, even if they state otherwise. This may include: (1) anything unfavorable that a parent does; or (2) unfortunate events that happen to themselves or family members. A child may take responsibility for the death of a sibling or parent or even how a parent treats the child. For example, a child may unsuccessfully attempt to cheer up a depressed parent and decide not that the parent has a problem, but that the child herself is boring and uninteresting. For example, I treated a young boy who was striving for autonomy but remained immature in many ways. Eventually it became clear that many of his immature behaviors and apparent learning weaknesses were essentially a result of his dependency on his mother. The boy wanted autonomy, but he was aware that she needed him to be dependent on her so that she had something to do. He worried that when he was in school, she would be lonely.

Children develop pathogenic beliefs when they identify with a parent or comply with what they are told about themselves. For example, a girl may see her mother renounce her education and decide that if her mother did not have an education, she is undeserving of her own education; or a boy may be told by his mother, ìYouíll never amount to much,î and the boy continues to sabotage his success.

A child may develop a pathogenic belief from either strain traumas or shock traumas. While both forms involve negative events for which the child may feel irrationally responsible, they differ in onset.

A strain trauma develops over a long period of time. For example, a child assumes that the parentsí continual arguments about money are a result of the child being a burden.

A shock trauma occurs as the result of an overwhelmingly traumatic event. For example, one little girl experienced a developmental arrest at the age of about four-and-a-half, when she almost lost her mother who was receiving radiation and had a bone marrow transplant. This little girl remained afraid of the dark, had immature articulation, and decided that being bold, moving ahead, and individuating was dangerous. She was in the midst of a developmental phase in all these areas at the time of her motherís illness and, in spite of being bright, she remained immature. She could not tolerate independence, and reading represented independence. She was afraid that her own developmentally appropriate boldness and competition with her mother was what made her mother sick. Play therapy permitted her to proceed with developmentally appropriate goals, including reading.

Motivation: One premise of this theory is that people are actually powerfully motivated to get better even if it is not immediately apparent.

Individuals have their own unconscious plan for overcoming pathogenic beliefs, will generally attempt the easiest problems first, and then, after assessing the level of safety in the environment, will tackle more difficult problems. This assumption supports one of the main premises of a good remediation plan, which starts at a level where success is certain. This assumption was demonstrated by the previous case material in which the little girl could not and would not read until she worked out other issues.

People enter therapy with their own plan, conscious and unconscious, for mastering problems. The psychotherapist can usually detect the plan within the first few therapy sessions. The Diagnostic Plan Formulation consists of a patientís goals, obstacles to reaching the goals, tests presented to the therapist, and insights.

Educational therapists have used similar plan formulations for remediation which begin with a good diagnosis of learning style and academic achievement, then, systematically, develop a remedial plan for the individual which is, in Control-Mastery terms, case-specific. This plan highlights learning strengths and weaknesses. For example, if dyslexia is an obstacle to learning, we explain it so the child has a coherent picture of what the term ìdyslexiaî means and how to compensate for it.

Safety: Individuals measure the safety in the environment prior to relinquishing their pathogenic beliefs and actually want others to provide an atmosphere of safety. A safe environment permits the discarding of maladaptive thoughts, feelings, and behaviors, as a step toward developing a new understanding of themselves and others.

Learning specialists have typically provided a safe environment by (1) starting at an academic level where the child is assured of success; and (2) identifying strengths and weaknesses and conveying a sense of hope that the process of remediation will permit the child to overcome learning difficulties. This process usually shows the child that the learning specialist is someone who can be truly helpful, and that she knows about these specific kinds of problems. It is important not to under- estimate those things that seem small to the specialist but offer something to the child that is significant and immediately helpful, such as showing the child a method of remembering the difference between bís and dís, or connecting cursive letters. In fact, an initial session should always contain something that the child can use immediately, whether it is a graph of strengths and weaknesses, a list of goals for remediation, a multiplication chart, or an outline for a book report that is due in five days. Also, it could be something like a promise to talk with the parents about not quizzing the child on math facts in a restaurant or to talk with the teacher about reading the spelling list just a little slower during the test.

Testing: The patient measures the level of safety or danger in the environment by testing relationships, especially the one with the therapist. These tests are unconscious and consist of two types: (a) Transference tests: The patient assumes that others will treat her the way she was treated by her parents. For example, in spite of being bright, a girl may appear timid and be reluctant to reveal what she knows. In a parent conference, information is shared that the father tends to lose his temper and say, ìDonít you have a brain in your head?î The girl comes to assume that everyone else will become easily angered and think she is incompetent. (b) Passive-into-Active tests: The patient treats the therapist the way others have treated the patient. For example, as in the previous instance, when the father says, ìDonít you have a brain in your head?î, the girl would have behaved in this instance toward the therapist in the same way as the father treated her. The girl would have become easily angered by any small mistake the therapist made, or not seen anything the therapist did as competent. In each testing situation the patient wants the therapist to pass the test by not repeating the unhealthy patterns of the past. The patient wants to repair the ability to have healthy interpersonal relationships.

Application to Educational Therapy Educational therapists disconfirm pathogenic beliefs by a cohesive, carefully planned approach and attitudes. By appropriately responding to the childís behavior and by providing a safe environment that permits the student to take the necessary risks to move forward, the therapist works in a manner which is consistent with Control-Mastery theory. Remediation disconfirms a variety of typical pathogenic beliefs firmly held by students, such as, ìIím dumbî; ìIím stupidî; ìIím dyslexicî; ìI have ADDî; ìI canít think of anything to writeî; ìI donít careî; or the recent basket term, ìWhatever...!î When an educational therapist formulates an Individual Educational Plan, it is parallel to what a psychotherapist does for a patient in the Diagnostic Plan Formulation. Goals are set, obstacles identified, and hypotheses are made regarding how the therapist can reach the individual. Educational therapists do this by a cohesive, carefully planned approach. By appropriately responding to the childís behavior and by providing an environment that permits the student to take the necessary risks to move forward, the therapist would be working in a manner which is consistent with Control-Mastery theory. A simple way to tell if the therapist is on track is to carefully observe what the student does immediately after the therapist does or says something. For example, I observed how a mother and her daughter approached the girlís homework. The girl did not want to do her homework, and her mother complained that they had frequent struggles whenever it was time to do homework. The girl struggled with reading, and the mother hated to see the girl struggle or be unhappy; therefore, the mother was not clear or consistent with the girl about homework time. The mother tried to explain it too much and make it fun. When the girl and her mother read together, the mother would immediately tell the girl each word that the girl did not decode, so the girl would not struggle. I noticed that the girl would become visibly annoyed each time the mother offered the word or explained the assignment. When asked why she was upset about her motherís help, the girl firmly informed both of us that she wanted to figure out the word on her own, and she hated it when her teacher or mother gave her the word. She went on to request that her mother and I tell her classroom teacher that she could do the work on her own when given that extra time. The motherís ambivalent and permissive parenting style, desire to help too much, and need to make each assignment fun, was not what the girl needed or wanted. The girl wanted to be autonomous, needed to have extra time and help only when she asked for it, and clear structures and limits. While a relatively small sector of the worldís population will experience long-term psychodynamic psychotherapy, the majority of people will attend school. It could be helpful if classroom teachers, educational therapists, pediatricians, and others who work closely with children knew about psychological processes (D. J. Cohen, M.D.; J. Sikorski, M.D., personal communication, 1996). For example, teachers interact with children all over the world almost daily, for many years of a childís life, and they make a lasting impact on the lives of their students. Educational therapists evaluate and treat children effectively and provide an atmosphere in which people can see the benefit from this process-oriented work. These professionals, as well as others, can refine their individual work with children if they are well informed about psychodynamic processes. Control-Mastery theory provides this coherent approach.

Cohen, D. J. (1996). Presidentís Message (1996), International Association for Child and Adolescent Psychiatry and Allied Professions, No. IV. New York.

Levi, G., M.D., Mazzonceni, B., Ph.D., Penge, R., M.D., Sechi, E., M.D. (1994). Psychopathological Risk in Children With Learning Disabilities. Paper delivered at Thirteenth International Congress, International Association for Child and Adolescent Psychiatrist and Allied Professions.

Sikorski, J. (1996). Academic Underachievement and School Refusal. Handbook of Adolescent Health Risk Behavior, edited by R. J. DiClemente et al. New York: Plenem Press.

Sikorski, J. (1996). Personal communication.

Weiss, J. (1993). How Psychotherapy Works: Process and Technique. New York: Guilford Press.

Suggested Reading

1. Stern, D. (1985). The Interpersonal World of the Infant: A View From Psychoanalysis and Developmental Psychology. New York: Basic Books.

2. Weiss, J., Sampson, H., The Mount Zion Psychotherapy Research Group (1986). The Psychoanalytic Process: Theory, Clinical Observations and Empirical Research. New York: Guilford Press.

3. Ungeleider, Dorothy (1985). Reading, Writing, and Rage. Rolling Hills, California: Jalmar Press.

4. Sikorski, J. (1994). Trauma and Psychic Development: Perspectives from Risk Studies and Developmental Psychopathology. Paper presented to the organizing committee for the Thirteenth International Congress.

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