THE PLAN FORMULATION METHOD FOR COUPLES: UMBERTO AND DANIELA, A CLINICAL EXAMPLIFICATION OF A PFMC BASED PSYCHOTHERAPY INTERVENTION.

Control Mastery Theory (CMT) is a cognitive-dynamic relational theory of psychological functioning and psychopathology (Weiss, 1993; Gazzillo, 2016). A central tenet of CMT is that human beings are guided by an unconscious plan to achieve adaptive goals, disprove their pathogenic beliefs by testing them with the therapist and master their traumas. Also couples try to pursue healthy goals, and the partners test each other to disconfirm the pathogenic beliefs that obstruct them (Zeitlin, 1991). If partners don’t pass their reciprocal tests, couples may develop relational vicious cycles impairing their adaptation and well-being. The Plan Formulation Method for Couples (Rodomonti M., Crisafulli V., Mazzoni S., Curtis, J., Gazzillo F., 2019), is a case-specific assessment procedure aimed at reliably formulating the couples’ plan. This contribution presents the case of Umberto and Daniela, a couple treated according to their PFMC. They looked for a couple psychotherapy because they often argued and were very frustrated and worried about the healthy development of their two years old child. Their therapy lasted 16 sessions. During the therapy, Umberto and Daniela, worked to understand the feelings and pathogenic beliefs that gave rise to their principal vicious relational circles. Daniela proposed mainly transference tests by non-compliance of her-self-hate and burdening guilty, expressed by her complaining, and Umberto’s reaction via angry outbursts or absolute compliance with all of Daniela’s requests, which was expression of his omnipotence and burdening guilty tested with transference tests both by compliance and by non-compliance. The therapist helped the couple also remain aware of the virtuous relational circles (resources) that enable them to feel safe in their relationship. At the end of the psychotherapy, Daniela and Umberto were arguing less, enjoyed more their ability to take care of their daughter and had new projects for the future of their family

A METHOD FOR THE ASSESSMENT AND INTERVENTION IN WORKING WITH COUPLES: THE COUPLE'S PLAN AND ITS APPLICATION TO A CLINICAL CASE

According to Control-mastery theory (CMT; Weiss, 1993; Gazzillo, 2016), patients come to therapy in order to get better, and they have a plan for doing so (Weiss, 1993; Silberschatz, 2005, 2012). Following the suggestion of Denis Zeitlin (1991), we extended this hypothesis also to couples who look for a treatment. The aim of this work is to suggest a method for the assessment of couples based on the CMT and its implementation to in couple therapy. We hypothesized that also the couple that seeks psychotherapy has a couple’s plan (Crisafulli, Rodomonti, 2017), which comprises goals, pathogenic beliefs, traumas, tests, dysfunctional relationship patterns -vicious relational circle-, resources -virtuous relational circle- and insights. In order to formulate the couple’s plan, the clinician/rater should have access to the transcriptions of: one/two couple sessions; one/two individual sessions; a couple session aimed at talking about what emerged during the assessment and about the specific treatment proposed to them. The empirical tool which may be useful for this task are: the Interpersonal Guilt Rating Scale-15 (IGRS-15, Gazzillo et al., 2017) and the Pathogenic/Problematic Beliefs Scale (PBS; Silberschatz, 2016), both in their clinician and self-report forms. In the clinical case we will present, the couple’s plan allowed to better understand the dysfunctional dynamics underlying the individual and dyadic suffering and gave to the couple the opportunity to understand the meaning of their own and the partner's behaviors, emotions, reactions. This application of CMT is both in line with the main approaches to couple therapy and is innovative. Indeed, the couple's plan may provide the clinicians -particularly young therapists- with a useful compass for understanding couple’s complex dynamics and planning case-specific interventions. Moreover, a work aimed at solving couple’s problems can generate positive indirect consequences on the functioning of the whole family system

Psychopathology and adaptation to environment: Fonagy model compared to Weiss model

In the recent transition of Fonagy and collaborators’ thinking, psychopathology results from a lack of resilience which, in turn, results from a lack of epistemic trust, which is an adaptive consequence of the early social learning environment and leads to limitations in the capacity to mentalize and properly evaluate interpersonal situations. The possibility to read psychopathology as the adaptation of the child to traumatic environment is indeed the core of the Control-Mastery Theory (CMT). According to CMT, the child is “wired” from birth to adapt to his reality; to this aim, starting from what he learns from the caregivers, he constructs, by inference from experience, a system of beliefs, more or less reliable, on himself, others, and his social world. Some of these beliefs are pathogenic when they associate an internal (feeling of shame or guilt) or external (departure or loss of the caregiver) danger to the achievement of a healthy and realistic goal. Once again, psychopathology results from an adaptation to traumatic experiences in childhood, but, in this case, the adaptation is mediated by a system of beliefs and, so, by the extreme trust that the child has in his caregiver

Una bussola per la comprensione delle dinamiche di coppia: il metodo per la formulazione del piano della coppia (MFPc)

La Control-Mastery Theory (CMT) è una teoria psicodinamico-cognitiva di natura relazionale del funzionamento mentale e della psicoterapia (Gazzillo, 2016; Weiss, 1993) sviluppata ed empiricamente validata dal San Francisco Psychotherapy Research Group (Weiss, Sampson e Mount Zion Psychotherapy Research Group, 1986). Uno degli assunti principali della CMT è che le persone che richiedono una psicoterapia siano guidate da un piano inconscio (Silberschatz, 2005, 2008; Weiss, 1993) che prevede la realizzazione di obiettivi sani e piacevoli e la disconferma delle credenze patogene che si sono sviluppate come conseguenza di esperienze traumatiche infantili e che ostacolano il paziente nei suoi sforzi di adattamento. Anche nella vita quotidiana le persone mettono alla prova le proprie credenze patogene e le relazioni intime, in virtù della loro stabilità e del coinvolgimento emotivo che implicano, rappresentano un contesto ideale affinché i partner possano tentare di disconfermarle (Zeitlin, 1991), sperando di ricevere dall’altro risposte diverse da quelle dei propri caregivers traumatici. Quando ciò non accade, nella coppia si sviluppano vissuti negativi e sintomi che possono spingere i partner alla ricerca di un trattamento psicoterapeutico. Ipotizziamo che anche le coppie, sin dall’inizio della terapia, siano guidate da un piano inconscio e l’obiettivo del nostro lavoro è quello di fornire le linee guida per la Formulazione del Piano della Coppia. Il Piano di coppia comprende gli obiettivi; gli ostacoli; i traumi individuali e di coppia; i circoli viziosi, ovvero l’incastro delle credenze patogene dei partner che genera pattern disfunzionali; i circoli virtuosi, che garantiscono ai membri della coppia di sentirsi al sicuro nella relazione; infine, gli insight. Le diverse componenti del piano di coppia verranno illustrate tramite l’aiuto di un caso clinico e verranno riportati i risultati dei due self report utilizzati: l’Interpersonal Guilt Rating Scale-15 (IGRS-15, Gazzillo et al., 2017) e la Scala delle Credenze Problematiche (PBS; Silberschatz, 2016). Il Piano della coppia rappresenta un metodo di valutazione e intervento nel lavoro con le diadi coniugali e genitoriali, utile al terapeuta -soprattutto se giovane- per orientarsi nella clinica e al ricercatore per comprendere le dinamiche disfunzionali alla base della sofferenza individuale e diadica.Control-Mastery Theory (CMT) is a cognitive-psychodynamic theory of psychological functioning and psychopathology (Gazzillo, 2016; Weiss, 1993), empirically validated by the San Francisco Psychotherapy Research Group (1986). A central tenet of CMT is that people who seek for psychotherapy are guided by an unconscious plan (Silberschatz, 2005, 2008; Weiss, 1993). Such unconscious plan provides for the realization of healthy and pleasant goals and the disconfirmation of the pathogenic beliefs that have developed as a consequence of childhood traumatic experiences and which hinder the patient in his adaptation efforts. Even in everyday life people test their pathogenic beliefs and intimate relationships, thanks to the stability and the emotional involvement that they imply, represent an ideal context for the partners to try to disconfirm their respective pathogenic beliefs (Zeitlin, 1991), hoping to receive different responses from those received by their traumatic caregivers. When this does not happen, the couple develops negative experiences and symptoms, which may encourage partners to seek for a psychotherapeutic treatment. We hypothesize that not only individuals but also couples are guided by an unconscious plan at the beginning of the therapy and the aim of our work is to provide guidelines for the Formulation of the Couple’s Plan. The couple's plan includes goals, obstructions, individual and couple traumas, vicious circles such as the matching of pathogenic beliefs of both partners that generate dysfunctional patterns, virtuous circles which guarantee members of the couple to feel safe in the relationship, and finally the insights. The formulation of each component will be explained with the help of a clinical case and the results of the self-report measures used - the Interpersonal Guilt Rating Scale-15 (IGRS-15, Gazzillo et al., 2017) and the Pathogenic/Problematic Beliefs Scale (PBS; Silberschatz, 2016) - will be reported. The couple's plan represents a method of assessment and intervention in the work with conjugal and parental dyads, which is useful both to the therapist - especially to the young therapist - to orientate himself in the clinical work, both to the researcher, to understand the dysfunctional dynamics underlying individual and dyadic suffering

VICIOUS RELATIONAL CYCLES: A METHOD FOR ASSESSING COUPLES FROM THE PERSPECTIVE OF CONTROL MASTERY THEORY

Thanks to the stability and the emotional involvement that they imply, couple relationships represent an ideal context where the partners can test their respective pathogenic beliefs (Zeitlin, 1991). The aim of this work is to present a method for the assessment of couples according to Control Mastery Theory (CMT) and its implementation to one married couple and one parental couple. The first couple wanted to improve their communication skills while second is a high-conflict couple (Carter, 2011) that needed a support of co-parenting. The procedure we followed consists of: (1) a couple session; (2) one or two individual sessions oriented to the Plan Formulation Method; (3) another couple session aimed at talking about what emerged during the assessment and about the specific treatment proposed to them. The tools used for the plan formulation are: the Interpersonal Guilt Questionnaire-67 (IGQ-67, O'Connor et al, 1997), the Interpersonal Guilt Rating Scale-15 (IGRS-15, Gazzillo et al., 2017) and the Pathogenic / Problematic Beliefs Scale (PBS; Silberschatz, 2016), both in their clinician and self-report forms, and the Shedler Westen Assessment Procedure-200 (SWAP-200, Shedler, Westen, Lingiardi, 2014). In both cases, the pilot study shows that factors such as the personality, beliefs, guilt, and partners’ attitudes provide information useful to understand the functioning of the couple or co-parents and for planning a case-specific treatment. Moreover, if the partners can observe directly and clearly the circular dynamics powered by the contributions of each of them, it is possible to develop a greater awareness of dysfunctional dynamics and a stronger motivation to the intervention. Future studies are needed to increase our sample in order to evaluate the reliability and validity of this method, correlating the procedure with the assessment of the process and outcome of the treatment

Progress in Psychotherapy: The Perspective of Control-Mastery Theory

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

The plan formulation method for couples (PFMC): early results.

According to Control-Mastery Theory (CMT; Weiss, 1993; Gazzillo, 2016), patients who look for a therapy have an unconscious plan aimed at disconfirming pathogenic beliefs, overcome problems, mastering traumas, and achieving developmental adaptive goals. Following a suggestion of Zeitlin (1991), we have hypothesized that also couples, when look for a psychotherapy, have a couple’s unconscious plan (Rodomonti et al., in press) which includes their goals, pathogenic beliefs, traumas, tests, vicious relational circles, virtuous relational circles and insights. On the basis of the first three-four sessions of their therapy, therapists can understand patients’ plan and formulate in a reliable way following a validated procedure: the Plan Formulation Method (PFM; Curtis et al., 1994). The aim of this work is to propose a method for the assessment of couples based on CMT and to show the early results of its validation: the Plan Formulation Method for Couples (PFMC), an adaptation of PFM. The PFMC follows the same steps indicated by Curtis (1994) for the PFM and involves four independent clinical judges that have access to the transcriptions of early couple’s therapy hours. The reliability is measured for each component of couple’s plan by calculating intraclass correlation; then less relevant items are deleted by determining the medians of judges’ ratings for item. At last, a separate judge removes the redundant items. We present the early results concerning the plan formulation of four couples in therapy which show - in line with previous research studies conducted in individual settings (Silberschatz, 2017)- that clinicians trained at CMT achieve high levels of inter-rater reliability in formulating the couple’s plan. PFMC enables to treat each couple in a case-specific way and provides the clinicians with a useful map for understanding couple’s complex dynamics and planning interventions

Through flow and swirls: modifying implicit relational knowledge and disconfirming pathogenic beliefs within the therapeutic process

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 able 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

Traumas and Their Consequences According to Control-Mastery Theory

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 Plan Formulation Method for Couples

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 therap