Masterson Institute

Treatment Approach

Dr James Masterson was a New York psychiatrist working with severe personality disorders in teenagers. He found that underlying their wild behaviour was a deep but hidden depression. He explained the depression using Object Relations Theory. The theory, which he applied to his exploratory early work with these patients, showed they had never developed a secure sense of self, suggesting personality disorder was neither neurotic nor innate; it was an unresolved problem of early childhood attachment. Masterson found that addressing this underlying abandonment depression radically altered the symptomatic behaviour of his acting out patients. The Masterson Approach has been refined and extended for 70 years since — notably by Dr Ralph Klein on schizoid disorders — but it has held to these original insights.

Object Relations Theory was a reformulation of Freud’s theories of the personality. But in Masterson’s hands the technique of therapy shifted: patients should take conscious responsibility for finding themselves (what he termed the 'real self'). This too has remained a feature of the Masterson Approach.

The Masterson Approach shares much in common with other forms of psychoanalytic psychotherapy deriving from Freud. Focus is on developmental issues, especially disruptions that derail normal emotional development. Attention is given to the unconscious drivers behind patterns of limiting thoughts and behaviours. The therapeutic relationship is instrumental to the process of change.  Treatment attendance is required to be on a regular basis of at least weekly sessions for optimum benefit.

Masterson therapists seek to work with patients to understand their specific underlying psychic structure and defences, which determines the most appropriate way of treating the patient and working through deep-seated issues. Helping patients activate their real self is central to the therapy.  Given the complex task of restructuring the self that is involved in this approach, treatment duration is most often medium to longterm.

To find a Masterson-trained therapist see the therapist directory on this website.



Psychotherapy is the best route to relief of the abandonment depression and discovery of the real self.
          James Masterson M.D.

The real self has a sense of continuity: it creates a tough core at the center of one’s personal identity that remains the same from one experience or crisis to another. A person recognises that he is somebody, who lives, works, and loves in a certain way, and it is taken for granted that the somebody is a worthwhile, competent human being, not immune to the sufferings of life, but capable of withstanding them and growing because of them.
          James Masterson M.D.

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