Therapy with survivors of narcissistic Abuse: Part 6 Five steps to case formulation

Now we’re ready to put it all together.  In this post I’m going to explain how to answer 5 questions about your client to know how you can best help them reach their goals.  First, I will show you a diagram that you can use in your own clinical work and apply it to the case of Sarah that I introduced in part 1 of this series.

This post is the last 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

 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’


What are this client’s goals for therapy? What pathogenic beliefs – conscious or unconscious – stand in the way? Key traumas that gave rise to PB’s? How might the client  test the PB’s out with the therapist?  What kinds of  therapist interventions/attitudes would be helpful to them?
To engage in an activity (e.g. swimming) that client enjoys on a regular basis “If I don’t take responsibility for other’s emotional wellbeing then they will fall apart.” Father prone to sullen depressive episodes and would only feel better when Sarah was at home and working hard to cheer him up. See whether therapist agrees/disagrees with her practice of putting others’ needs ahead of hers. Challenging Sarah’s assumption of responsibility for others’ emotional health in her life.
See whether therapist requires Sarah to take care of the therapist’s emotional needs. Demonstrating in attitude and presence that you are capable of caring for your own needs (e.g. end sessions on time, address issues of payment as needed).
See whether therapist will support her efforts to prioritize her own emotional wellbeing ahead of others. Affirm Sarah’s displays of self-care.


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 *