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Compliance, according to Control Mastery Theory, is an emotional, cognitive, and behavioral response to trauma that reflects the beliefs that “you deserve what you get” and “you get what you deserve.” Patients “comply” when they 1) believe their distorted pathogenic beliefs are true, 2) act as if these beliefs were true, 3) reenact in present relationships traumatic, pathological interactions experienced earlier in childhood, and 4) tend to protect parents by justifying their hurtful behavior.
Compliance results from the fact that children tend to believe parents as absolute authorities. Because of family loyalty and a wish to protect parents, children may assume the worst about themselves in dysfunctional families. Then they may act in ways that make their negative self-image true, consistent with the notion of a “self-fulfilling prophecy”. Based on these deeply embedded negative self-images and self-destructive roles, children may repeat these patterns long into adult life. Along with “pathological identifications”, the concept of “compliance” helps clinicians understand the origins of many self-destructive behaviors and why patients are so loathe to relinquish them. Clinical examples will illustrate the usefulness of understanding the role of compliance as well as treatment techniques.