Therapy with survivors of narcissistic Abuse: Part 3 The Client’s Pathogenic Beliefs

Why would someone get anxious the more successful they get?

Is ‘fear of success’ something to take seriously in treatment?

What sorts of internal compromises do children of narcissistic parents have to make?

The answer to all of these questions – from the perspective of CMT – point to pathogenic beliefs.  In today’s post I’m going to explain how and why someone might come to adopt a pathogenic belief, the functions they may serve for the child of an emotionally compromised parent, and how you can infer which beliefs your client might want help freeing themselves of in therapy with you.

Today’s post is the third 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 CMT 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’

Why do pathogenic beliefs develop?

In short, when a child’s developmental goals seem to conflict with the relationship to a parent then the child will have to be the one to compromise and this is where pathogenic beliefs come in.  A pathogenic belief is a rule that tells the child terrible dangers will ensue if s/he pursues a developmental goal.  For example, in the case of Sarah that I have described in the prior posts in this series, she learned that if she paid more attention to herself than to her father that he would collapse into a depression and be unavailable to her.  Since paying attention to oneself is a developmentally appropriate process for a child and adolescent, she had to find a way to surrender this developmental goal.  By adopting the pathogenic belief or rule that if she didn’t take responsibility for others’ emotional wellbeing then they will sink into depression, she adapted to her situation in a way that preserved her father as a viable parent to her.  If she had not adapted in this way and paid more attention to herself than her father then she would have courted the trauma of his not being there.  For a child a parent’s absence – whether emotional or physical – feels worse than not being able to pursue a developmental goal or process.  Children are too psychologically, emotionally, and sometimes physically dependent on a parent to let that relationship not matter to them.

And I don’t mean to imply that Sarah, as a young girl, literally thought to herself “Dad will fall into a depression if I don’t cheer him up”.  Control-Mastery Theory talks about pathogenic beliefs in ways that lay out the logic of the child’s adaptation in such a situation.  It may be more useful to the therapist than the client to articulate pathogenic beliefs like this.  However it’s useful for the therapist to know that articulating a pathogenic belief is a way of capturing the cognitive, emotional, and behavioral responses enacted by a child to cope with the stress brought on by having a psychologically compromised parent.

How to infer a client’s pathogenic beliefs

A client’s pathogenic beliefs can be identified by thinking about their goals for treatment, the thwarted developmental aims those goals may reflect, the kinds of traumas experienced by this client earlier in life (to be discussed in detail in the next post), and your own sense of and experience of the client.  If you can determine what kinds of developmental goals the client seems to have had to give up then you can begin to think about what sorts of internal rules or beliefs may be in play that convinced the client that they must give them up.  Then you can couple these thoughts with an understanding of what sorts of adversity or trauma they faced in their early relationships that may have further convinced the child to abandon their own development.  Finally, you can use your own sense of the client.  Does this person seem comfortable and entitled to know and express anger?  Do they have an appropriate sense of entitlement to others’ respect, interest, and attention?  Do they expect that their feelings can be understood and usefully responded to by you?  These kinds of questions can help you determine what sorts of experiences or potentials may be missing for this particular client.  As you determine what ‘feels’ to be missing, this can inform what kind of pathogenic belief may be in play.

In my practice I help myself understand a client’s potential pathogenic beliefs by asking them to endorse a scale of pathogenic beliefs (known as the Pathogenic Belief Scale).  To give you an idea of what sorts of pathogenic beliefs are commonly seen in clinical practice I’ve listed the top 6 endorsed pathogenic beliefs from my practice.  These results come from 190 clients over 4 years:

  1. I fear being a burden if I ask people for help.
  2. I fear hurting others’ feelings if I express anger.
  3. If others feel bad, I am going to help, even if it means personal disadvantages.
  4. I am afraid of being rejected if I ask too much from others.
  5. If I succeed, at work or in private life, I usually play down my achievements.
  6. I fear to be rejected if I make mistakes.

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.

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