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Control-Mastery Theory

Synopsis:
Wise Counsel Interview Transcript: An Interview with Alan Rappoport, Ph.D. on Control-Mastery Theory

by David Van Nuys

Alan Rappoport, Ph.D.In this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews Alan Rappoport, Ph.D. on the topic of Control-Mastery Theory, a theory of how to do psychotherapy first described by Psychiatrist and Psychoanalyst Joseph Weiss, in the 1960s, and subsequently developed by other members of the San Francisco Psychotherapy Research Group.

Dr. Rappoport trained as an engineer while in college and spent his early career working as an engineer for the Lockheed corporation in Sunnyvale, CA (part of what later became Silicon Valley). Unfulfilled in this career path after five years, he left Lockheed and spent the next five years working odd jobs as a carpenter and exploring various interests, including Zen Buddhism and psychotherapy. He decided to become a psychotherapist, and ended up being one of the first graduates of the Pacific Graduate School of Psychology in 1981. His early work as a psychotherapist was non-traditional, in that he did therapy with socially phobic patients outside the office in the environments where they were fearful, and did emergency psychotherapy work as well through a telephone and house-call based program. He encountered the work of Joseph Weiss when a girlfriend at the time pointed out that Dr. Weiss and his colleague Psychologist Harold Sampson, Ph.D. were offering open case conferences through the Mt. Zion hospital. He appreciated the pragmatic approach to therapy conceptualization offered by Control Mastery theory and has now, over the years, become identified as one of the approaches' leading proponents.

Dr. Rappoport suggests that while the name "Control Mastery Theory" is not a particularly attractive one, it is useful in that the words "control" and "mastery" do refer to two of the major principles of the theory. The term "Control" describes the fundamental assumption made by the theory that people have unconscious control over their defenses. In English, the term refers to the idea that patients come to therapy in a defensive mode which they have chosen to enact in an unconscious fashion because these defenses have helped them to feel safe in past relationships; to "fit in". They probably never thought about it consciously, but they ended up doing the things that important people in their lives have expected of them, and thinking the thoughts that important people in their lives expected of them, all in the name of improving their acceptability to those important people. Usually, those important people are parents, but they can be other family and caregivers and authority figures as well. The end result is that a social facade ends up being constructed in the form of one or more social roles which the person has so rehearsed that they may not know who they really are outside of these roles. Importantly, these controls or defensive structures can relax and they can tighten up. They become most relaxed when people feel deeply accepted, and they tense up when people feel at risk for judgment.

The term "Mastery" refers to another cornerstone assumption of Control Mastery Theory, which is the idea that people are innately motivated to heal themselves (e.g., to learn how to function without their defenses constraining their natural inclinations), although they may not know exactly how to accomplish that task.

What happens in therapy, as seen through the eyes of a Control-Mastery therapist, is that patients begin to test their therapists to see if the therapist will judge them or hold them to the role expectations that past important relationship partners held them to. Control Mastery therapists recognize two ways that such tests occur. The first involves traditional transference as understood by old school psychodynamic psychotherapists, wherein the patient acts towards their therapist in the same way that they acted towards their important past relationship figures. The second sort of test, referred to as a "passive-into-active" test, is a sort of inverted transference, where instead of re-enacting a past relationship with a caregiver in relationship to the therapist, the patient reverses the past relationship roles so that they start acting like the caregiver did rather than the way that they did themselves. As an illustration of these two sorts of tests, consider a person who was abused as a child. If that abused person comes into therapy and starts acting, unconsciously, as though the therapist was going to abuse them too, that would be the traditional transference test. If, however, the person comes into therapy and starts acting in an abusive or bullying fashion towards the therapist, that is an example of the passive-into-active test, where the patient reverses their past roles and re-enacts not their own past role, but the role of their past "caregiver".

The job of the Control-Mastery therapist is to pass the patient's tests so as to help the patient understand at an unconscious level that the new therapy relationship is fundamentally safe, and that the defensive controls are not necessary. When this safety has been successfully communicated, the patient can relax and let their defensive guard down, which is inevitably a therapeutic occurrence.

Dr. Rappoport contrasts Control Mastery theory with other approaches to therapy, including both traditional psychodynamic psychotherapy and cognitive therapy. Both of these approaches, he notes, assume that the therapist is in a position to "fix" the patient through the application of some technique. This puts pressure on the therapist to enact the desired change, and also may feed into assumptions patients may have that they are powerless to enact change themselves. An added problem is that any direct attack on defenses (such as a direct attempt to talk about unconscious decisions) may backfire, causing a person to feel less understood and hinder rather than help therapy progress.

The Control Mastery approach is fundamentally egalitarian rather than authority or hierarchical based. It is also pragmatic and agnostic concerning choice of psychotherapy technique, also in contrast to these other forms of psychotherapy. Whereas dynamic therapists always turn to interpretation of transference to do their work, and cognitive therapists turn to cognitive restructuring activities, Control Mastery therapists are willing to use any technique they can get their hands on so long as it helps them to accomplish their goal of helping their patients to decide (unconsciously) to let down their guard. They are thus results oriented, rather than theory oriented. Their assumption is that patients are inherently motivated to heal, and will do so on their own when they are given a safe space within which to do the exploration necessary to allow this to happen. It is not the therapist's responsibility to impose a technique through which change will occur, but rather to enable the patient to feel safe enough to do the work necessary to heal themselves. This work will occur spontaneously as the patient is enabled to relax their defenses. In Control Mastery, the patient, and not the therapist, sets the pace and agenda of therapy.

The typical unfolding of a Control-Mastery therapy psychotherapy would involve the patient offering a series of tests to the therapist whose job it is to recognize them and not engage them in such a way which will trigger the patient's defenses. As the therapist passes these tests, the patient will relax and become more comfortable during therapy, at which point they will also become more free to understand and correct the nature of the problem that has brought them to therapy. Dr. Van Nuys asks Dr. Rappoport about a hypothetical patient who comes in expecting the therapist to fix them. Dr. Rappoport responds that this request is likely a test in itself, the wrong answer to which would be to respond in a way that encouraged the patient to continue to feel unempowered about helping themselves.

The visible signs of progress in psychotherapy are those that signal relaxation and decreasing formality. These include signs of physical relaxation such as sitting back in the chair, deep breathing, increased spontaneity and increased willingness to share thoughts, memories and associations. Anything that causes the opposite sort of reaction; a tightening up of people's responsiveness is a negative result, and a sign that whatever incident or technique such a tightening up was in response to was not a useful intervention with the particular patient. Therapeutic techniques need to be chosen on an individual basis as they will benefit each patient. It is not appropriate to apply the same techniques to different patients on the assumption that the techniques themselves have inherent benefit. Rather, it is in the interaction between the therapist and the patient and the techniques where the benefit will occur.

Dr. Rappoport emphasizes the fundamental Control-Mastery goal of the creation of a safe and fundamentally accepting therapy environment. This is imperative to the progress of the therapy, because if the patient doesn't feel safe in therapy, he or she will not be able to let down their defenses and have the emotional space necessary to do the therapeutic work. According to Dr. Rappoport, safety is the opposite of defensiveness, and assisting the patient in becoming non-defensive is a primary goal of therapy.

Dr. Rappoport also emphasizes the need for Control Mastery therapists to truly enjoy the work they do. They must illustrate in a completely genuine manner, the freedom from defensiveness that patients are unconsciously seeking to emulate. Patients will know if the therapist is faking it, or is burned out. They will also know if the therapist is genuine and respond in an unconscious fashion by becoming more genuine themselves. Some patients will enter therapy suspecting that they are a burden, and it is important that the therapist not start to see their patient in this fashion (which is another test offered to the therapist by the patient). To the extent that the therapist experiences the patient as a burden, the patient will not feel free to become non-defensive.

Dr. Rappoport closes the interview by recommending two books for those people who desire to know more about Control Mastery Theory. Those books are, "Transformative Relationships: The Control Mastery Theory of Psychotherapy ", edited by George Silberschatz, and "How Psychotherapy Works: Process and Technique " by Joseph Weiss, MD.

In listening to this interview and preparing this summary, I (Mark Dombeck, Ph.D.) am struck by how closely Control-Mastery Theory appears to be alligned with the classical humanistic psychotherapies such as Carl Rogers' Client-Centered Therapy, and Fredrick Perls' Gestalt Therapy. Both of these humanistic therapies make assumptions about the intrinsic health benefits of an identity formed on an organismic basis (e.g., in reference to one's own innate desires), rather than in response to the demands of society and family (e.g., in reference to duty and honor and shame). Both of these therapies promoted the idea that the task of the therapist was to help the patient uncover or recover his or her intrinsic self by providing an accepting and nurturing therapeutic environment, and both assumed that patients would know how to accomplish this goal intrinsically if they could only get out from the demands society put upon them. Neither Dr. Rappoport nor Dr. Van Nuys raised this possibility in the interview, but it does appear to my (perhaps naive) eyes that Control-Mastery Theory might be reasonably well thought of as a modern-day descendant of such humanistic therapies. In any event, it is certainly a "client-centered" form of psychotherapy.
 
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