Therapy with survivors of narcissistic Abuse: Part 1 Overview of Control-Mastery Theory

Are you a therapist or helping professional who works with survivors of narcissistic abuse?

Would you like to tailor treatment to your specific client’s goals?

Would you like to know how you can attune to and support the ways that client’s are working to heal themselves?

If you answered yes to any of these questions then this post and this series may be for you.  In today’s post I am going to provide an overview of a theory of therapy that I use to good effect in my clinical work with survivors of narcissistic abuse.  It is called Control-Mastery Theory and it offers a client-focused, flexible and psychodynamic understanding of how you can aid in your clients’ efforts to help themselves.  One of the beautiful things about the theory in my opinion is that it assumes that all survivors of narcissistic abuse are inherently motivated to overcome the traumatic impacts of a narcissistic parent or partner.  The job of the therapist is to tune into that motivation and align the therapy with it.  In this 6-part series I hope to offer you a primer on how to do this.  Along the way I’ll be mentioning different resources that can accelerate your understanding of CMT and how you can apply it with survivors of narcissistic abuse.

Today’s post is the first in a series on CMT and how you can learn to apply this theory in your own clinical work.  It’s a 6-part series that covers these topics:

Part 1 Overview of Control-Mastery Theory

Part 2 The Client’s Goals

Part 3 The Client’s Pathogenic Beliefs

Part 4 The Client’s Key Traumas

Part 5 How Clients may Test Pathogenic Beliefs

Part 6 Five steps to case formulation

This series is about Control-Mastery Theory in general.  If you want to learn more about how to apply this form of therapy specifically to survivors of narcissistic abuse then check out my 3-hour online course on the topic.

My name is Jay Reid and I’m a licensed psychotherapist in California who specializes in the treatment of survivors of narcissistic abuse.  I work from a form of therapy called Control-Mastery Theory which prizes the client’s efforts to overcome the trauma of narcissistic abuse and realize a fuller and richer quality of life for themselves.  If this topic interests you then I encourage you to learn more by getting my free e-book on ‘Effective Therapy with Survivors of Narcissistic Abuse: The basics of Control-Mastery Theory

Control-Mastery Theory (CMT): An overview

Have you ever wondered how and why clients obtain insight in therapy?  Insight is usually defined as a conclusion that a client was consciously unaware of but through the course of therapy is able to realize this conclusion and feel a sense of emotional release.  Freud saw insight curative and the holy grail that all analysts should strive towards.  As thinking about therapy has moved towards the actual relationship between client and therapist, the role of insight has become more of an epiphenomena to the main vehicle of change – the therapeutic relationship.  Research supports this shift as it’s the therapeutic alliance that accounts the most for client improvement relative to other factors like insight.

Well in the late 1970’s and 1980’s two men and their colleagues in San Francisco came up with a way to explain why it’s the relationship between client and therapist that’s the ‘thing’ in the Shakesperean sense.  Joseph Weiss & Harold Sampson found time and again that clients tended to achieve insight in therapy after they felt safe enough with their therapists to do so.  So, insight didn’t lead to cure but relational safety led to insight.  And they laid out a very compelling story as to how a client searches for conditions of safety with the therapist and what happens once those conditions were met.  Before I explain that part, I want to talk a little more about why clients seek therapy from the point of view of this theory – something called Control-Mastery Theory (CMT).

Why clients seek therapy

Clients often come to therapy because they feel stuck in their lives.  Somehow or another they know they are not living in a way that feels as fulfilling and worthwhile as they hope they are capable of.  Weiss and Sampson theorized that this can happen when a client is living under the auspices of a pathogenic belief.  These kinds of beliefs represent rules for living that at onetime afforded them relief from grave dangers.  They reasoned that clients use therapy to help them disconfirm such pathogenic beliefs so they feel freer and safer to pursue the developmental goals that such beliefs interfere with.

Let’s say a 3 year old girl named Sarah has a father who is prone to bouts of depression where he appears listless, watches tv for hours on end, and seems disinterested in his daughter.  Sarah observes that her father does spring to life when she leaves her toys out.  He grows animated and yells at her to pick up the toys.  Sarah feels worried and concerned about her father when he is in his depressed states and every day tries to cheer him up.  She excitedly tells him stories from school, and puts on dances and plays intended to cheer him up.  He would seem enlivened by her efforts then return to his state of depression.  She resolves to keep up such efforts as a way to protect herself and her father from his bouts of depression.  To do this, she develops a pathogenic belief of “If I don’t take responsibility for other’s emotional wellbeing then they will fall into depression.”

Why are such beliefs ‘pathogenic’?  In other words why do these beliefs become the ‘genesis’ of pathos or psychological suffering?  In a nutshell, if the belief requires the child to sacrifice a normal developmental goal in order to comply with it, then the belief is pathogenic.  Sarah in this example had to sacrifice her own developmental need to focus on her needs and life and have a parent who was emotionally sturdy enough to support her in this need.  Instead she had to stay preoccupied with her father’s happiness or lack thereof and put his needs way before hers.

As Sarah reaches adolescence and adulthood she may find herself always checking on whether friends and partners are happy and putting her own needs way in the back of her life.  As a result she will likely feel depleted, anxious and like her relationships feel very one-sided.  If Sarah comes to therapy then CMT would suggest that she might be looking for an experience that allows her to know that she can safely turn her attention to her needs without risk of the therapist falling into a depression like her father seemed to.

How safety leads to insight

In this example, Sarah worked in therapy to see whether it was necessary to adhere to her pathogenic belief that if she doesn’t take responsibility for the other’s emotional wellbeing then they will fall into a depression.  At first, she displayed a lot of interest in the therapist and would feel compelled to exaggerate her gratitude for his interpretations or reflections.  As he seemed to demonstrate and possess his own source of inner buoyancy she seemed to feel more and more assured that he may not require the same emotional caregiving that her father did.  As the therapy progressed, she would more boldly pay attention to her needs by starting sessions off right away with what she wanted to talk about.  At the start of therapy she had made a point to ask how the therapist was doing and about his weekend before she could begin to talk about her own life.

A few months into the therapy, Sarah began to talk about how burdened she felt by her father’s depressive states.  She seemed to gain “insight” in the form of remembering how she would have to decline her friends invitations to play at their homes after school out of a sense of duty to come home and entertain her father.  She similarly recalled how lonely and socially isolated this left her.

Sarah’s new awareness of how she suffered as a result of her father’s depressive episodes only seemed available after she felt assured enough that she could safely attend to her own needs in the face of her therapist’s ability to take of his own emotional wellbeing.

After observing clients like Sarah find such conditions of safety in the therapy before gaining insight, Weiss and Sampson prioritized safety as the main ingredient to alleviating psychological suffering.

In part 2 of this series I’m going to explain in depth how CMT thinks about the client’s goals for treatment.  And in this series, I’m focusing on the basics of CMT.  If you want to learn how to apply this theory in a rich and nuanced way to survivors of narcissistic abuse then I encourage you to check out my 3-hour course and online Facebook group for helping professionals who are interested in learning in-depth how to effectively apply Control-Mastery Theory to survivors of narcissistic abuse.  In it I cover the ways a child to a narcissistic parent is neglected, forced to think ill of themselves to share a reality with that parent, and how you empower such survivors to identify and challenge the beliefs that at onetime protected them abandonment or attack in relationship to their parent but now constrict their lives and potentials.  I’m also excited to announce that there is an accompanying facebook group where helping professionals can come together to discuss their own clinical triumphs, challenges, observations and questions in working with this type of client.  The course is priced in a manner that will hopefully be a low barrier to entry so that as many professionals who are interested can join.

Jay Reid is a Licensed Professional Clinical Counselor (LPCC). If you are considering therapy for overcoming a childhood with one or more narcissistic parents please contact me for a free 15-minute phone consultation.

Related Articles


Your email address will not be published. Required fields are marked *