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Pathogenic Beliefs and Their Relevance in Psychotherapy ISSN: 2572-4037 Kadur et al. Int J Psychol Psychoanal 2018, 4:032 DOI: 10.23937/2572-4037.1510032 Volume 4 | Issue 2 International Journal of Open Access Psychology and Psychoanalysis CASE STUDY Pathogenic Beliefs and their Relevance in Psychotherapy: A Written Case Study Jennifer Kadur1*, Irina Flaig1, Jana Volkert2, Isa Sammet3 and Sylke Andreas1,4 Check for updates 1Institute of Psychology, Alpen-Adria Universität Klagenfurt, Universitätsstr, Austria 2Department of Psychosocial Prevention, University of Heidelberg, Germany 3Institute for Synergetics and Psychotherapy Research, Paracelsus Medical University, Austria 4Department of Psychology, University Witten/Herdecke, Germany *Corresponding author: Jennifer Kadur, Institute of Psychology, Alpen-Adria Universität, Universitätsstr. 65-67, A-9020 Klagenfurt, Austria, Tel: +43-0-463-2700-1634, Fax: +43-0-463-2700-991604 dynamic-relational theory developed by Joseph Weiss, Abstract Harold Sampson and the Mount Zion Psychotherapy Objective: Goals of this single-case study are to assess Research Group [1]. The theory describes and explains whether tests according to Control Mastery Theory (CMT) can be reliably identified by trained raters and to examine the behavior of a patient as well as the therapist´s in- whether the Psychotherapy Process Q-Sort method can ad- terventions during psychotherapy. The theoretical equately represent the test situation. assumptions are based on Freud’s later ideas, partic- Method: A single case was analyzed by well-trained psy- ularly on his hypotheses of the unconscious ego and chology graduates on the basis of the Plan Formulation superego [1]. Weiss [1] assumed that people adapt to Method. The interrater reliability of the identified tests was the environment from their first years of life because examined. In addition, the tests were classified according to attachments to significant others are important for the the Psychotherapy Process Q-Sort. representation of self and others. Thereby people de- Results: 70 test situations were identified with acceptable velop conscious and unconscious constructs of them- overall interrater reliability and slightly better values for sin- gle categories. The Q-Sort analysis indicated 34 items that selves and their environment that are based on their were assigned more than 5 times to 3 tests. Overall, a com- experiences and guide their behavior [2]. According to bination of more than five Q-Sort items represented one test Weiss [3] these constructs can be dysfunctional because situation. of traumatic experiences. These constructs are called Conclusions: These findings demonstrate that even well- pathogenic beliefs and are the result of the adaptation trained graduates can identify tests. Indeed, the Psycho- process, which is typically unconscious. For example, “a therapy Process Q-Sort does not suffice to adequately rep- young boy who experienced himself as neglected by his resent the test concept according to CMT. parents, developed the pathogenic belief that he would Keywords and should be neglected, not only by his parents, but Psychotherapy, Control mastery theory, Single case study, also by others” [4]. Psychotherapy process Q-Sort, Reliability Pathogenic beliefs impede the normal development of the child [5]. These beliefs tell the person that if he Background or she wants to achieve a certain realistic and reason- Control mastery theory able goal, that person will endanger him-or herself or loved others. Pathogenic beliefs are developed in early Control Mastery Theory (CMT) is a cognitive-psycho- childhood within the relationships with significant oth- Citation: Kadur J, Flaig I, Volkert J, Sammet I, Andreas S (2018) Pathogenic Beliefs and their Relevance in Psychotherapy: A Written Case Study. Int J Psychol Psychoanal 4:032. doi.org/10.23937/2572- 4037.1510032 Accepted: October 15, 2018: Published: October 17, 2018 Copyright: © 2018 Kadur J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Kadur et al. Int J Psychol Psychoanal 2018, 4:032 • Page 1 of 10 • DOI: 10.23937/2572-4037.1510032 ISSN: 2572-4037 ers (e.g., parents) upon which the child depends for sur- Weiss [1] differentiated between transference tests vival. Thus, every threat to this relationship is traumatic and passive-into-active tests. In a transference test, the for the child. patient attempts to determine whether the therapist will cause trauma as his parents or significant others Traumatic events can be classified into shock trauma did. In this test, the therapist assumes the role of the and stress trauma. Shock trauma is defined as a severe parents. For example, a patient who was often criticized traumatic event, such as the illness or death of a par- by his parents will manifest behavior in therapy that the ent. The child may feel responsible for the death or dis- patient assumes will lead the therapist to criticize him, ease; the child may think that a certain wish or behavior e.g., being late for the sessions. Turning passive into ac- caused this event. For example, a child who is hostile tive tests, the patient assumes the role of the parents to his parent before the parent’s unforeseen death may and behaves in a traumatizing manner toward the ther- assume that his hostility caused the parent’s death. This apist. The patient described above, for example, may pathogenic belief can be permanent because the conse- criticize the therapist for his high fee or his unhelpful quence was so dramatic and traumatic [1]. treatment. Both types of tests repeat the patient’s trau- Stress trauma occurs if the child thinks that a certain matizing experiences with his parents. Both behaviors wish or goal endangers his relationship with his parents. are strategies of defense and simultaneously strategies The child then avoids this wish or goal and develops a to overcome the problem. If the therapist reacts in a pathogenic belief, for example, “It is dangerous to be- manner that helps the patient to disconfirm his patho- come independent”. Children often feel responsible genic belief, the therapist passes the test and his behav- for everything that occurs. They think they deserve the ior is called pro-plan. If the therapist’s reaction confirms trauma and therefore tend to repeat the traumatic situ- the belief, the behavior is anti-plan [1]. ation even if it causes the child to suffer [1]. Pathogenic beliefs often influence a person’s control over his uncon- Empirical evidence scious mental life. Such beliefs are a powerful source of Generally, patients are testing more or less continu- motivation that can lead people to behave against their ously during therapy, using minor and major tests. Sev- conscious will to avoid danger. However, a pathogenic eral studies provide evidence that a high rate of passing belief is constricting and inhibiting and is accompanied tests is directly associated with better outcomes com- by feelings of shame, guilt and anxiety. Thus, people are pared with a high rate of failing tests [9-11]. Silberschatz highly motivated to overcome their pathogenic beliefs and Curtis [10] demonstrated that therapeutic interven- [1]. tions, which are pro-plan and disconfirm the patient’s Patients’ plans in psychotherapy pathogenic beliefs, lead to immediate improvement for the patient. Silberschatz [10] observed a similar result: Patients who enter psychotherapy are seeking help if the therapist passed a test, the patient became less to disconfirm their pathogenic beliefs [6]. Weiss [3], Sil- anxious and more friendly and relaxed. Sammet, et al. berschatz [7] and Curtis and Silberschatz [8] developed [9] observed a higher level of insight with good pro-plan the plan concept that describes how patients pursue an interventions. unconscious plan for seeking help to solve and master Although these studies confirm the hypotheses of their problems and disconfirm their pathogenic be- CMT, there has been relatively little direct empirical liefs. There are three methods with which to disconfirm evidence for the reliability of Weiss’s [3] test concept pathogenic beliefs: (1) Developing insight, (2) Using the until now. Silberschatz and Curtis [11] examined the in- therapeutic relationship or (3) Directly testing with the terrater reliability of five independent raters in the iden- therapist [6]. tification of two patients’ tests. The analysis showed Tests are experimental actions that the patient uses good reliability of r(k) = 0.50 and r(k) = 0.75 (3). Another to verify the validity of his pathogenic beliefs. He uncon- analysis of the interrater reliability of the identification sciously hopes that the therapist will act in a manner of tests was demonstrated by Silberschatz [10]. Nine that disconfirms those beliefs, allowing the patient to graduate students analyzed verbal transcriptions of develop a healthier or an alternative behavior. In a test 100 psychotherapy sessions of a patient and identified situation, the patient acts according to his pathogenic test sequences. Subsequently, three psychoanalytically belief, which tells the patient that his behavior will en- skilled raters identified key tests, observing 46 central danger his relationship with the therapist. If the thera- test sequences with a very good reliability of rkk = 0.82 pist is not affected by this behavior, the patient becomes (rll = 0.63) [10]. less anxious and can take a step
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