Within the psychoanalytic and systemic traditions, dysfunctional couple conflicts have been mainly understood as the consequences of three broad factors: (1) the excessive use of projective identification (Nielsen, 2019), (2) the presence of deficits in the abilities of mentalization and affective regulation (Feeney & Fitzgerald, 2019), and (3) the collapse of effective communication strategies (Ringstrom, 2012). Moreover, research (Crenshaw et al., 2021) has highlighted the importance of specific topics that trigger couple conflict, suggesting that dysfunctional interactions can be the outcome of communication deficits and stressing the influence of gender roles on demand/withdrawn conflict configurations.

Notwithstanding the theoretical and clinical importance of the topic of chronic couple conflictuality, there have been no empirical studies analyzing chronic conflictuality from the perspective of control-mastery theory (CMT), which is an integrative, cognitive-dynamic relational theory of psychic functioning, psychopathology, and the psychotherapy process. CMT was originally developed by Joseph Weiss and empirically validated by the San Francisco Psychotherapy Research Group and the Control-Mastery Theory–Italian Group (Gazzillo et al., 2021; Gazzillo, 2023; Silberschatz, 2005; Weiss, 1993; Weiss et al., 1986). According to CMT, human beings (consciously and unconsciously) exert some degree of control over their mental processes by following a safety principle (Fiorenza et al., 2023) and are intrinsically motivated to adapt to reality, master traumas, and solve problems. To adapt to reality, since infancy they have learned to develop a system of beliefs (conscious/unconscious, explicit/implicit) about reality and morality that will guide them throughout adulthood. According to CMT, psychopathology stems from the unconscious pathogenic beliefs developed to adapt to childhood traumatic and adverse experiences (Fimiani et al., 2020). These beliefs are considered pathogenic because they associate the pursuit of healthy and adaptive goals with harm to the self, to significant others, or to important relationships, and arouse fear, shame, or guilt (Bush, 2005; Faccini et al., 2020; Gazzillo, 2022). Many of these pathogenic beliefs result in maladaptive interpersonal guilt.

CMT has deepened the understanding of five broad families of pathogenic beliefs that fuel interpersonal guilt: (1) survivor’s guilt, which is based on the belief that having more success, capacity, wealth, and so forth than loved ones makes them suffer; (2) separation/disloyalty guilt, which is based on the belief that separating, differentiating, and becoming autonomous from loved ones will hurt them; (3) omnipotent responsibility guilt, which stems from the belief that one has the duty and power to make other people feel happy and must take care of loved ones in distress, putting aside any personal need; (4) self-hate, which involves the feeling that one is inherently wrong, inept, and bad and, thus, undeserving of love and respect from others; and (5) burdening guilt, which is derived from the belief that one’s own needs are unduly burdensome to others.

Because these beliefs are constricting and painful, people are often unconsciously powerfully motivated to disconfirm them, testing them in their close relationships (even therapeutic ones). Tests involve communication, attitudes, and behaviors (unconsciously) aimed at disproving pathogenic beliefs. By testing, people actively seek—albeit unconsciously—experiences that will help them master the traumas underlying those beliefs (Fimiani et al., 2022). Usually, a patient tests his/her therapist by expressing or stirring up emotions that are stronger than usual (Gazzillo et al., 2022a, 2022b, 2022c; Gazzillo et al., 2022a, 2022b, 2022c); making an implicit or explicit request; behaving more absurdly, illogically, or provocatively than usual; or placing the therapist in a situation where they feel pressure to intervene in some way (Weiss, 1993). When the therapist passes the patient’s tests, through communication, attitudes, or interventions that are experienced by the patient as disconfirming the pathogenic belief, the latter will likely become less anxious and depressed and more involved in the therapeutic work and relationship, gain new insights, and show other signs of improvement.

According to the CMT, there are two main testing strategies: transference testing and passive-into-active testing. Someone conducting a transference test may behave as though the pathogenic belief that they want to disprove is true (transference test by compliance) or behave in a way that defies it (transference test by noncompliance). The hope is that the other person will respond differently from traumatizing parents/others when the individual tries to pursue adaptive goals that they fear will cause danger or harm. In passive-into-active testing, the person puts the other in a position similar to the one they previously held in a traumatizing situation or relationship. The person may identify with a traumatizing caregiver and treat another person in a way that they previously experienced as traumatizing (passive-into-active test by compliance). Conversely, the person may treat the other the way they would have wanted to be treated (passive-into-active test by noncompliance), hoping that this person will appreciate that behavior and, thus, legitimize their thwarted infantile needs. Thus, by observing the other’s response to both kinds of passive-into-active testing, the person can begin to disprove pathogenic beliefs (Gazzillo et al., 2019; Gazzillo et al., 2022a, 2022b, 2022c).

By virtue of the adaptive unconscious motivation and abilities of patients to get better through therapy, patients usually come into psychotherapy with a more or less conscious plan to achieve their healthy goals, disconfirm their pathogenic beliefs (mainly through testing activity), and master their traumas (Gazzillo et al., 2019). This plan underlines the general areas the patient wants to work on and the patient’s likely approach for undertaking this work, and it can be useful for the therapist to deliver a case-specific treatment (Gazzillo et al., 2022a, 2022b, 2022c), that is, a therapy set up and conducted based on the specific goals, pathogenic beliefs, traumas, and testing strategies of a patient. The therapist’s task is to support the patient’s plan by providing pro-plan responses.

The Plan Formulation Method (PFM) is an empirically validated, standardized procedure that has been developed and validated to formulate the patient’s plan (Curtis & Silberschatz, 2022). It has five components: (1) healthy and adaptive goals, (2) the pathogenic beliefs obstructing the achievement of these goals, (3) the traumas that contributed to the development of the pathogenic beliefs, (4) the ways in which the pathogenic beliefs might be tested within the therapy (tests), and (5) the kind of understanding (insights) or experiences that may be helpful for the patient to gain.