Safety in control-mastery theory

Abstract

This study presents an overview of the development of the main psychoanalytic conceptions regarding safety, an aspect that has received increasing attention within the psychoanalytic literature. After describing the hypotheses of Sigmund Freud, Joseph Sandler, John Bowlby, and Harry Stack Sullivan, the study focuses on the ideas proposed by Joseph Weiss and on control-mastery theory (CMT), a cognitive-dynamic relational theory of mental functioning, psychopathology, and psychotherapy. Unlike other models, CMT stresses that human beings need to feel that both themselves and the people they love are safe; each person, however, may need something different to feel safe. Two clinical vignettes are used to illustrate how the therapist can understand, from the outset of the therapeutic process, how to help the patient feel safe, stressing the case-specific nature of the conditions of safety.

Key words:

• psychoanalysis
• safety
• control-mastery theory
• plan
• psychotherapy

Disclosure statement

The authors report there are no competing interests to declare.

Notes

1 In 1952, Winnicott wrote an essay on the “Anxiety associated with insecurity,” where he talked about the fact that an infant can feel “insecure” because of deficits in the holding they receives from their mother.

2 Two authors who may be considered forerunners of Bowlby’s theory of attachment and whose views radically differed from the Freudian perspective were Hermann (1943) and Suttie (1935). Hermann describes the instinct in primates (including humans) to cling to caregivers, especially in situations of danger and stress. Suttie argues that the innate need for sociality is the infant’s only means of survival and is independent of genital appetites. In The origins of love and hate, Suttie (1935) suggests that the need for tenderness in a small child is a primary need that was not based on hunger or sexuality. The child needs the protection, care, and tenderness of the mother, and when they are deprived of their mother’s loving behavior, they lose their sense of safety.

3 Other psychoanalysts, such as Melanie Klein (1932, 1957) and Donald Winnicott (1958, 1963, 1965), highlight how the perception or fantasy of having damaged the love object/environment mother because of one’s own aggression/ruthless love is a source of intense distress for the person. The child realizes that the bad object being attacked is also the good object that provides care and need satisfaction. This generates an anxiety about losing the object and the need to repair it. However, these feelings are not based on altruistic concerns: in fact, the child fears losing the object because they need it; without the living and whole object that supports them, the child’s ego might become vulnerable and break into pieces.

4 All clinical case names are pseudonyms to ensure patient privacy. The patients described have given their therapist consent to use their material for this study, and the clinical material has been disguised.

Additional information

Notes on contributors

Eleonora Fiorenza

Eleonora Fiorenza is a PhD student at the Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Italy, and a clinical psychologist.

Marianna Santodoro

Marianna Santodoro is undergoing PsyD training on a psychodynamic psychotherapy Master’s program at Scuola di psicoterapia dinamica dell'adolescente e del giovane adulto (SPAD), Rome.

Nino Dazzi

Nino Dazzi is professor emeritus at the Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, and former dean of the Faculty of Psychology, “Sapienza” University of Rome, Italy.

Francesco Gazzillo

Francesco Gazzillo, PhD, is associate professor of dynamic psychology at the Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Italy, a psychodynamic psychotherapist, and president of the Control-Mastery Theory Italian Group.