A Different Slant on CMT, Part I

Control-Mastery is like other therapeutic approaches in that it is based on a theory that mixes statements about human nature with concepts derived from therapeutic experience and supplements both with intuitive practice. While the mixture works just fine, it may prove helpful to see how the mixture can be brought together under a single theoretical framework based solely on assumptions about human nature.

In terms of a musical metaphor, Control-Mastery clinical descriptions typically have a Brahmsian flavor, while the present theory is written more in the spirit of Beethoven. What it lacks in emotional richness, it makes up for in structural clarity, particularly with respect to the human developmental process.

The theory will be developed with respect to the case of Kathy, which may be found in the Clinical Case Conference and in the paper by Polly Bloomberg-Fretter, entitled, "A Control-Mastery Case Formulation of a Successful Treatment for Major Depression," which was published in In Session: Psychotherapy in Practice, Vol. 1, No. 2, pp.3-17 (1995).

Axiom I:

The most important determinant of human behavior is an all-embracing concept of reality, a concept developed in childhood and then modified somewhat as a result of a person's later experiences.

A summary of what I mean by a concept of reality can be found in the writings of Joseph Weiss:

"A person's most powerful motivation is to adapt to reality, especially the reality of his interpersonal world. He begins in infancy and early childhood to work at adapting to his interpersonal world, and he continues to do so throughout life. As part of this effort, he seeks reliable beliefs (knowledge) about himself and his world. He works throughout life to learn how he affects others and how others are likely to react to him. He also works to learn the moral and ethical assumptions that others will expect him to abide by in his relations with them, and that they will abide by in their relations with him. He begins in infancy to learn about these things both by inference and from experience with his parents and siblings, and by their teachings.

"A person's beliefs about reality and morality are central to his conscious and unconscious mental life. These beliefs are endowed with awesome authority. They guide the all-important tasks of adaptation and self-preservation. They organize perception; a person perceives himself and others largely as he believes himself and others to be. In addition, such beliefs organize personality. It is in accordance with his beliefs about reality and morality that a person shapes his strivings, affects, and moods, and by doing so he evolves his personality. Moreover, it is in obedience to certain maladaptive beliefs, here called "pathogenic," that a person develops and maintains his psychopathology."

Weiss goes on to say: "The power of pathogenic beliefs derives from the fact that they are acquired in infancy and early childhood from parents and siblings, whom the child endows with absolute authority…. when in conflict with his parents, he tends to perceive them as right and himself as wrong….Pathogenic beliefs reflect the child's egocentricity, his lack of knowledge of causality, and his ignorance of human relations. The child tends to take responsibility for whatever he experiences. He may take responsibility for anything unfavorable that a parent does, or for anything unfortunate that happens to a parent. For example, he may take responsibility for the depression, illness, or death of a parent, or for the unfavorable ways his parents treat each other."

Pathogenic beliefs are treatable because they are founded on mistakes a child makes in forming its reality concept. Not all of the mistakes a child makes, however, result in pathogenic beliefs. Beliefs become pathogenic only when they stand in the way of a person attaining an important life goal. Even when such a conflict exists, though, it doesn't necessarily mean that the person will be highly motivated to overcome the beliefs.

For example, a child in growing up acquires from his parents a sense of how a man and woman relate to one another in marriage. This sense defines a host of expectations about what men and women will and will not do for one another and includes the presence or absence of shows of affection, sarcasm, bitter infighting, and the like.

A person will subsequently use this overgeneralized belief about how men and women relate to one another as a model in choosing a mate who seems willing to cooperate with the person in recreating the person's home environment. This mistaken overgeneralization can lead to a wonderful marriage if the person's parents enjoyed a warm, loving relationship. It can also lead to a disastrous choice in a marriage partner if the person's parents had a bad marriage, as happened with Kathy's first marriage. I want to say that the belief about how men and women relate to one another is pathogenic in the second case but not in the first, to which it may be argued that I am using the word "pathogenic" differently than it is used in clinical practice. Fair enough, but I am trying to make a few statements about human nature, and I contend that what I am calling pathogenic is only qualitatively different from the clinical reality--the two are not different in kind.

There is considerable evidence that people will seek to recreate their home environments in marriage irrespective of whether they had happy home lives as a child. The point is that even though a belief may conflict with the attainment of an important life goal (in this case, a happy marriage), it doesn't necessarily follow that the person will be highly motivated to combat that belief. What I am saying is that unhappiness in itself carries no motive power. To a person locked in by pathogenic beliefs, change will seem hopeless, so the motive to change will rarely get much beyond the daydream stage.

For a person's dissatisfactions to possess motive power, the person though experience must have gathered evidence that contradicts his childhood reality concept. Hope can take root as a dynamic force only where there is conflicting evidence and only to the extent that the contrary evidence mounts. What Control-Mastery therapists see in their clinical practice are only a small subset of those people who have become highly motivated to challenge their pathogenic beliefs by gathering a large amount of contrary evidence bit-by-bit over the course of their lives. How did they do this? By carrying out unconscious plans aimed at giving them the experiences they need to combat the beliefs.

Axiom II:

The unconscious testing that Control-Mastery therapists recognize in their patients is expressive of the normal human developmental process. It is something all humans do to grow.

We humans are knowledge seekers. So it is natural for us to extend the boundaries of our subjective reality concept. When it comes to that portion of our reality concept that has to do with fundaments of our personality and interpersonal relationships, however, we gather new information only in small bits and only when the quest is perceived as being "safe." I am using the term safe here exactly as Weiss does.

One reason we need to move slowly and cautiously is that personality-related childhood beliefs do not exist as an itemized list. They are all mixed together into an indefinable whole. Challenging one belief will have ramifications elsewhere. So only small steps can be taken and only in such ways that collateral implications can be dealt with. All that takes planning, unconscious planning.

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