The Core Sensitivities: A clinical evolution of

Masterson’s Disorders of Self

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Brooke E. Poulsen, DClinPsych, and Joseph J. Coyne, MClinPsych, School of

Psychology and Counselling, Queensland University of Technology, Brisbane,
Queensland

Introduction

Attachment theory has increasingly underpinned therapeutic interventions for both adults
and families (Daniel, 2006; Diamond et al, 2010; Maramosh, 2015; Mikulincer, Shaver &
Berant, 2013). An example emerging over the last decade is the Circle of Security
Intervention (COS; Powell, Cooper, Hoffman & Marvin, 2014) that is used to promote
secure attachment relationships between children and their caregivers. Drawing on theory
and research in attachment theory (e.g. Bowlby, 1969), the program also incorporates
research and theory on state of mind (e.g. Fonagy, Steele, Steele, Moran & Higgitt, 1991;
Slade, 2005) and object relations theory (e.g. Masterson, 1985). Initial data suggest that
the intervention has positive outcomes, leading to shifts in attachment security in young
children, from insecure to secure, and disorganised to organised attachment states of
mind (Hoffman, Marvin, Cooper & Powell, 2006). Although the intervention is run in
groups, one of the unique attributes of the protocol is the focus on individualised
assessment and treatment. Each caregiver-child dyad participates in a structured
assessment of attachment relationship, reflective function, and caregiving representations
that inform the intervention. A significant component of this individualised assessment is
the formulation of the caregiver’s core sensitivity (Powell et al., 2014). The core
sensitivities represent three “innermost concern(s) about preserving a coherent sense of
self within relationships” (Zanetti, Powell, Cooper & Hoffman, 2011, p. 324). The COS
originators developed the core sensitivities to conceptualise defensive processes and
their impact on relationships. The core sensitivities summarise particular concerns or
anxieties that each person holds in relation to their connections with others. They
describe the habitual ways the individual manages connection, shaped by the implicit
rules and requirements that were characteristic of the person’s own early attachment
relationships (Cooper et al., 2005).

The core sensitivities are defined around three main developmental concerns, emerging
from the caregiver’s own early interactions: difficulty with autonomy and separation
(separation sensitivity); difficulty with intimacy (esteem sensitivity); and difficulty with self-
integrity (safety sensitivity). As defined by Powell, et al. (2014), separation-sensitivity is

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characterised by a concern that being separate or individuating from the other precedes
abandonment. The discomfort with distance from another leads to a preoccupation with
whether the other person is available and loving enough, and attempts to maintain
closeness through compliance, helplessness, intensification of need, and pressure to
reassure or support. Esteem-sensitivity is predicated upon a belief that it is recognition for
performance and achievement that makes one worthy of connection to others, or worthy
of love. Esteem-sensitive persons are vigilant to signs of criticism, disagreement and are
particularly sensitive to others’ perceptions of them. Safety-sensitivity is exemplified by a
primary concern with the danger of being close to another. The safety-sensitive individual
is vigilant to signs of intrusion or control from others, and attempts to manage this
experience through self-sufficiency, avoidance of intimacy and dampening of the intensity
of emotional expression.

The COS intervention places explicit emphasis on understanding the parent’s own
struggle and the defensive processes that each caregiver relies upon to manage painful
affects and the experience of threat in relationships (Powell et al., 2014). The formulation
of the parent’s state of mind in terms of attachment and defensive functioning, in the form
of the core sensitivities, allows the therapist to adapt his or her approach and develop a
treatment targeted to these aspects. The formulation supports the clinician’s awareness
of the affects and dynamics that activate distress and emotional dysregulation for the
parent. This allows the therapist to sensitively maintain a reflective dialogue throughout
the distress, and to co-regulate that distress, thereby building a greater depth of relational
understanding within the caregiver. Through listening to the caregiver’s responses, the
therapist can gain a sense of the particular internal working models of the caregiver, and
specifically, the interactions and emotions that activate dysregulation and impact
caregiving (Cooper et al., 2005). Promoting caregiver reflective function is particularly
important given the body of research that has documented the impact of state of mind on
child development (e.g. Arnott & Meins, 2007; Fonagy, Steele & Steele, 1991; Fonagy &
Target, 2005) and its relevance to the therapeutic process more broadly (e.g. Fonagy,
2001).

Masterson’s Disorders of Self

The core sensitivities have their origins in Masterson’s (1976; Masterson & Klein, 1989;
1995) psychodynamic work on the disorders of self, which explored the developmental
origins and defensive processes that underlie the borderline, narcissistic and schizoid
personality disorders. An overview of Masterson’s theory will be presented here before
introducing the model of the core sensitivities. While Masterson (1985) outlined the
markers of healthy personality (labelled the real self), his focus was on the developmental
experiences, grounded in Mahler’s (1975) theory, that contributed to pathological or
impaired self-structures, which became the disorders of self (Masterson & Klein, 1995).

Mahler’s Theory of Separation-Individuation

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Mahler (1968) highlighted the role of the caregiver in shaping the child’s emerging sense
of self and independence. She theorised that in order to develop a sense of self, the child
in the first three years of life must separate from a symbiotic relationship with the
caregiver. This process was theorised to involve two complementary processes: the
child’s separation from the symbiotic relationship with the caregiver; and the development
of an individual sense of identity. Mahler divided this process into distinct phases that
corresponded with her observations of the infant-caregiver dyad. In the symbiotic phase
(two to four months), the infant is unable to differentiate between self and other, and inner
and outer. The infant has no ego functions and is dependent on the caregiver, who acts
as an auxiliary ego to regulate physiological and emotional states (Mahler, Pine &
Bergman, 1975). The separation-individuation phase (five to thirty months) is further
broken down into several sub-phases, but is concerned with the emerging capacity for
autonomy. At this time, the caregiver’s reinforcement and support for the child’s emerging
independence is essential. The caregiver is far enough away to allow the child to explore,
but close enough that the child can seek refuge or comfort if needed. With the increasing
recognition of the caregiver’s separateness, the child also becomes aware of aloneness,
and fears of losing the object or abandonment are observable. Similarly,
misunderstandings and conflicting goals become more evident in the relationship. The
child’s recognition that the caregiver has his or her own interests and goals, forces the
child to give up the sense of omnipotence that characterised the practising sub-phase, a
process termed the rapprochement crisis. The drive for autonomy co-occurs with the pull
for connection, creating ambivalence for the child, who simultaneously wants
independence but also the caregiver’s involvement. The caregiver’s attitude toward the
child during this phase significantly affects the child’s development of self. It is the
caregiver’s availability and support that allows the child to manage this ambivalence and
enables normal development (Mahler, 1968).

Mahler’s observations align with the assertions of attachment theory: the caregiver is
essential in responding to both the child’s needs for separation and individuation (secure
base) and for emotional refuelling and connection (safe haven) Bowlby (1988). These
fundamental needs are reflected in the COS, with the caregiver providing support for both
autonomy and relatedness (Powell et al., 2014).

Masterson (1976) proposed that the pattern of these interactions becomes internalised
and guides the organisation of personality. The caregiver’s responses to and regulation of
the child’s needs for closeness and connection and autonomy shape their emerging
sense of self, their capacity for closeness and their approach to affect regulation
(Masterson, 1976). It is through this structure that affects are understood, and either
regulated or experienced as dangerous and unmanageable. Each disorder of self is
characterised by impairments in one or more capacities of the self (Masterson &
Lieberman, 2004). The child, unable to express all needs, develops a defensive structure
that allows the maintenance of closeness to the other and minimise the painful affects
that are associated with those parts of self that are not accepted, tolerated or contained in
the relationship with the caregiver (Masterson & Klein, 1995).

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Borderline Disorder of Self

Phenomenology. The borderline disorder of self is characterised by a reliance on others,

and a particular sensitivity to signs of rejection and abandonment (Masterson, 1976). The
individual equates individuation with withdrawal of the other and correspondingly avoids
self-expression and self-activation, to maintain closeness (Masterson & Lieberman,
2004). Experiences of rejection are accompanied by intense affect and may manifest as
panic, hopelessness, helplessness and rage (Masterson, 1976).

Developmental origins. The pathology of persons with borderline personality disorder is

suggested to originate in disruptions to the process of separation-individuation,
specifically the rapprochement sub-phase (Masterson, 1976). Those with a borderline
disorder of self are believed to have missed out on support for independence and
individuation as a child. The parent, unable to tolerate the child’s emerging independence,
withdraws availability and support (Masterson, 1981). Rather than encouragement, the
child’s attempts to explore and separate from the parent were met with unavailability,
withdrawal or hostility, while continued dependency and need for the parent was
encouraged (Manfield, 1992). Acts that assert independence and separation were
equated with emotional distance from the caregiver, activating feelings of helplessness,
panic and emptiness (Masterson, 1976). This creates a conflict between the child’s
strivings to grow and to develop autonomy, and the ongoing and powerful need for
attachment (Masterson, 1988).

Intrapsychic structure. These themes of reward for dependence and withdrawal for
autonomy are internalised and shape the child’s intrapsychic world (Masterson &
Lieberman, 2004). Those with a borderline personality disorder are said to hold two
prominent self-representations that correspond to specific object representations with
distinct accompanying affects (Masterson, 1976). A ‘good’ object-representation, where
the object is experienced as rewarding and connected corresponds to a self-
representation as good, but passive and dependent. The ‘bad’ object-representation is
experienced as withdrawing, hostile and disapproving of separation-individuation, with the
self experienced as inadequate, bad, and unlovable (Masterson, 1976). This withdrawing
object representation, along with feelings of loss, isolation, panic and anxiety, is activated
by actual experiences of separation or moves by the individual towards psychosocial
growth and separation-individuation. This split object relations unit remains separate
through the use of defenses that allow the individual to maintain the sense of self as
good, which correspond to feelings of being loved and worthwhile, and to avoid the
abandonment depression that accompanies the bad self (Masterson & Lieberman, 2004).

The primary defences drawn upon are those of regression, clinging and splitting
(Manfield, 1992). In order to avoid depression associated with abandonment, the
individual avoids opportunities for expression, to assert unique wishes or to be competent
or capable (labelled self-activation), all of which may lead the caregiver (and later
significant others) to abandon the individual (Masterson, 1976). Splitting is the defence of
keeping contradictory object and self-representations, and their associated affects
separate. The reality of feelings of abandonment is avoided by striving to retain the

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positive object relations unit and a disconnection from the implications of the avoidance of
self-activation (Masterson, 1976). The innate drive towards separation-individuation is
relegated in order to avoid the withdrawal of the caregiver. Because of these defences,
certain ego functions or capacities of the self do not fully develop. Firstly, the individual’s
capacity for autonomy, assertion and self-activation are sorely impaired. Secondly, skills
in emotion regulation are impaired. As the child relies on the caregiver to regulate painful
affects, avoidance of individuation and self-assertion interferes with the development of
the capacity to regulate the self, independent of another (Masterson & Lieberman, 2004).

Masterson (1976) developed the concept of the borderline triad to understand and attune
to the client’s psychology as it plays out in relationships, including the therapeutic
relationship. The triad describes the sequence from event to affect to defence, and has
been pivotal in informing psychotherapy with individuals who have borderline personality
disorder. Self-activation is described as the capacity to identify and express unique and
individual wishes and opinions, to act on our own behalf and to retain an independent
sense of self (Masterson & Lieberman, 2004). Situations and relationships that require
self-activation are experienced as dangerous to the client with a borderline personality
structure, as they signal the potential for abandonment, and accompanying feelings of
emptiness, isolation and the sense of self as completely worthless. The activation of
these painful feelings associated with the early separation or withdrawal of the caregiver
triggers defence against the feeling, for example via dependency or subjugation of needs
in favour of another’s. The person has come to see that the only way to maintain the love
and connection to another is to be dependent and enmeshed (Masterson, 1981).

Narcissistic Disorder of Self

Phenomenology. The narcissistic disorder of self is characterised by an investment in

the self that manifests as grandiosity, the seeking of recognition and praise, and a focus
on maintaining control and perfection (Masterson, 1981). This focus on achievement and
perfection allows the individual to protect against the feelings of emptiness, and fear that
the self is inadequate (Masterson, 1981). The narcissistic personality is dominated by the
internalised assumption that connection is equated with competence. It is only through
reinforcement from external sources that those with a narcissistic disorder of self can
avoid a sense of despair and depression associated with the belief that the true self is in
reality inadequate and unlovable (Masterson & Lieberman, 2004). Those with a
narcissistic personality disorder work to maintain a barrier against vulnerability, and are
hypersensitive to perceived criticism or disapproval which is interpreted as a rejection of
the self and a signal of inadequacy or worthlessness of the core self (Manfield, 1992).
Intimate relationships pose a significant threat, as the ability to truly connect with another
person requires an honesty and vulnerability that a person with a narcissistic disorder of
self cannot safely manage (Masterson & Klein, 1981).

Developmental origins. To understand the developmental bases of the narcissistic

disorder of self, Masterson (1985) distinguishes between the exhibitionistic/grandiose
narcissist, and the closet narcissist. The person with a grandiose narcissistic disorder of
self exudes an aura of self-importance, assuredness and competence (Masterson, 1993).

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The internal sense of worthlessness and weakness that they also feel can be disavowed
providing the sense of self as capable and superior can be maintained and reflected by
others. To maintain this state, this individual needs to believe in his or her superiority, the
belief that others are ‘less than’ and are valuable only for their provision of idealisation.
The closet narcissistic disorder is characterised by themes of idealisation and
devaluation, and feelings of shame, inferiority and sensitivity to criticism, similar to the
grandiose narcissistic disorder (Masterson, 1993). However, the self is maintained by
emotional investment in the object. Distinct from the borderline disorder of self, closet
narcissism is characterised by reliance on the other to provide mirroring. The person with
a closet narcissistic disorder of self is not overtly exhibitionistic, he or she maintains a
sense of self-esteem and value by fusing with the idealised object (Masterson, 1993).

Masterson (1981) hypothesises that the narcissistic disorder of self has its developmental
origins in the practising sub-phase of Mahler’s theory of separation-individuation. The
developmental focus in this phase is on the child’s investment in his or her own skills and
increasing mastery over the body and environment. The child becomes invested in this
functioning and develops a sense of pride and omnipotence. The narcissistic disorder is
thought to arise from the caregiver’s criticism, derision or humiliation of the child’s
omnipotence or active devaluation of the child’s abilities (Masterson & Lieberman, 2004).
Connection with the parent was maintained by downplaying the self, and revering the
caregiver instead. This admiration and idealisation of the parent allowed the child to retain
the closeness and connection with the parent. The developing sense of self is not
mirrored with accuracy, and results in the experience of profound emptiness and
worthlessness (Manfield, 1992). The false self is maintained only through ongoing
mirroring, sought either through inflation and grandiosity, or the positive reflection of being
close to the special or admired other.

Manfield (1992) suggests that the caregiver fails to resonate with the child’s actual
experience and affect. The child learns that the only way to maintain the love of others is
to be perfect. To reveal vulnerability is to risk losing connection with others; thus, it is
defended against, either overtly in the case of the individual considered a ‘grandiose
narcissist’, or covertly in the case of the individual considered a ‘closet narcissist’. The
caregiver’s connection to the child is contingent. While support is given for achievements
that represent the child’s (and often the caregiver’s own) competence and success, the
caregiver becomes critical, attacking or withdrawing at other times (Manfield, 1992). The
caregiver uses the child as an extension of their own needs for idealisation and may hold
high expectations for the child that, when met, are rewarded with connection, admiration
and pride. When these conditions are not met, the parent, experiencing a sense of
devaluation, may become hostile, devaluing and denying of the child. The child’s real self,
one that has needs, vulnerabilities, and makes mistakes is met with scorn, derision or
shame (Masterson & Lieberman, 2004).

Intrapsychic structure. Consistent with the implicit assumption that connection is

conditional on specialness and performance, Masterson (1981) suggests that the
narcissistic disorder of self is characterised by two object relations units: the defensive

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object relations unit and the aggressive object relations unit. In the defensive object
relations unit, the self is viewed as perfect, special, important and valued, corresponding
with the view of other as omnipotent. The other is seen as holding the power, perfection
and reinforcement necessary for idealisation and mirroring. In this representation, the self
is experienced as special, unique, admired and recognised (Masterson & Lieberman,
2004). This defensive structure protects the individual against the aggressive object
relations unit, where the self is experienced as deflated, unworthy, inadequate and empty.
This view of self is activated by any experience of inadequacy, imperfection or
vulnerability. It corresponds with a representation of the object as harsh, critical or
devaluing (Masterson, 1981).

Defences are employed to avoid the feelings of being worthless, humiliated, unfulfilled
and empty, that correspond with the aggressive object relations unit (Masterson, 1981).
The individual is preoccupied with avoiding criticism and negative evaluation from others,
seeking to project the self as flawless, special or worthy. Grandiosity and self-importance
are motivated by the need to maintain mirroring and reinforcement from others that
support the elevated image of the self (Masterson & Lieberman, 2004). Denial of
weakness, of vulnerability and imperfection allows the individual to avoid the feelings of
depression, isolation and aloneness that are triggered by feelings of inadequacy
(Masterson, 1981). Rather than experiencing the pain of depression, anger or rage allows
distress to be directed outward, and is evident in tendencies to devalue others. This acts
as a secondary defence against feelings of humiliation, worthlessness and shame
experienced in the face of perceived criticism or vulnerability (Masterson, 1981).

Schizoid Disorder of Self

Phenomenology. Ralph Klein (Masterson & Klein, 1995) described the developmental
origins and object relations that underpin the schizoid disorder of self. A person with
schizoid personality disorder balances two interpersonal dangers. To be intimate with
another places the individual at risk of engulfment; however, to be distant is to risk
complete isolation (Masterson & Klein, 1995). Relatedness is associated with submission,
compliance and victimisation; there is a fear of being taken-up, overwhelmed or intruded
upon by the other. This has been labelled the master-slave unit, characterising one of the
primary self-object representations (Masterson & Klein, 1995). However, to be distant
from people is associated with a fear of non-existence or exile. It is associated with a
sense of loss and disconnection that is equally as painful as being close to another
(Manfield, 1992).

Individuals with a schizoid disorder of self may appear odd and aloof, yet often describe
themselves as feeling overwhelmed by affect, rather than lacking it (Fairbairn, 1984).
According to Klein (Masterson and Klein, 1995), the characteristic anxiety of the person
with a schizoid disorder of self is engulfment, diffusion, or some other loss of self-integrity.
Labelled the fundamental schizoid dilemma (Guntrip, 1968) the central challenge for the
individual is that he or she is uncomfortable in a relationship with another, but also cannot
live without human attachments (Masterson & Klein, 1995). A balance is sought between
enough distance to reassure the individual of his or her safety, but not so much as to be

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alienated and exposed to the threat of non-existence (Masterson & Klein, 1995). The term
‘schizoid’ derives from observations of ‘schisms’ between the internal and external life of
the individual (Guntrip, 1968). While appearing overtly detached, the person with a
schizoid disorder of self will usually describe a deep longing for closeness and intimate
involvement. Withdrawal and introversion are the primary defensive mechanisms drawn
upon to maintain this balance.

Developmental origins. Both Klein (Masterson & Klein, 1995) and Guntrip (1968)
provide a detailed description of the etiology of the schizoid personality disorder. It is
suggested that in early childhood, the child’s attempts at connection with the caregiver
have been met with indifference or neglect. Yet, at other times, the parent may have been
intrusive, overwhelming the child with their own emotion. The child may have experienced
the caregiver as an ‘appropriator’. This is a type of relating where the child feels that they
are engaged by the parent to fulfil a function, rather than being experienced as a person.
As a result, the child sees that connection is not possible without risk of annihilation or
appropriation. However, the primary need for attachment remains, and the threat of
isolation can also be overwhelming. The parent’s over-involvement and impingement,
coupled with the derision or indifference to the child’s own needs and affect seems to
foster a self-sufficiency and detachment in the child, who sees the need to protect the
“core, inviolable self” (McWilliams, 2010, p. 55). As Fairbairn (1984) wrote, “in early life
they gained a conviction whether through apparent indifference or through apparent
possessiveness on the part of their mother, that their mother did not really love them as a
person in their own right” (p. 113). This is distinct from the borderline and narcissistic
disorders, where connection, although only under specific conditions, remains possible.
The pain that characterises the schizoid disorder of self is that connection is not possible
without some compromise of self, and complete isolation is experienced as a real
possibility.

Intrapsychic structure. The intrapsychic structure of the schizoid disorder of self is

comprised of two object relations unit. The first, labelled the master-slave unit consists of
a self-representation as a slave who provides some function for the object, who is
experienced as manipulative, coercive, or misappropriating. The object is experienced as
wanting to use and not relate (Masterson & Klein, 1995). The individual’s experience is
that connection is only possible where he or she is under the control of the other, and
remains submissive and compliant. The second object relations unit comprises a
representation of self as alone, in exile, isolated, but self-sufficient and contained.
Although disconnected, the self is safe from intrusion and control (Masterson &
Lieberman, 2004).

The person with a schizoid personality structure typically relies on defenses or

‘compromises’ of self-sufficiency and fantasy (Roberts, 2005). As relationships are
perceived as perpetually controlling, smothering or depriving, self-sufficiency is
defensively relied upon to the exclusion of any dependence or need for another. Second,
an extensive fantasy life in which the individual holds close connections with others may
take the place of real-life attachments (Masterson & Lieberman, 2004). For a person with

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schizoid personality disorder, the fears of both closeness and isolation exist
simultaneously, each activating distress. The formation of attachments, closeness to
others and sharing feelings signal a threat for those with a schizoid disorder of self, who
experience a strong affect of fear of being used, exploited, or overwhelmed by the other.
In response, the individual will typically withdraw, distancing from the other, and
potentially drawing upon fantasy to maintain connection (Masterson & Lieberman, 2004).

The Core Sensitivities

Research over the last 20 years based on attachment theory, infant research and
developmental neuroscience (e.g. Siegel, 2012; Schore, 2003) has provided further
support for the role of early interactions in development of the self. Masterson’s work
provides a valuable conceptualisation of the contributions of developmental experiences
to the formation of the self, and provides a framework for integrating interpersonal and
defensive style with developmental theory. The COS utilises these concepts, but expands
their application. Powell et al. (2014) argue that the disorders of self represent extreme
variants of patterns that can be conceived of dimensionally. These authors have taken the
central concerns of each of the narcissistic, borderline and schizoid character styles, and
extended these to apply to all individuals with the aim of better understanding how
developmental experiences shape interpersonal and intrapsychic functioning (Cooper et
al., 2005). Fundamentally, each core sensitivity represents an internal working model,
holding the rules that guide relationship in an attempt to avoid coming in contact with
unregulated affect (Powell et al., 2014).

Cooper et al. (2005) hypothesise that core sensitivities are central to the organisation of
personality. They form a part of the individual’s stable psychic structure that, although
open to change, appear to remain relatively consistent over time and across
relationships. The authors also clarify that by using the terminology core sensitivity they
aim to emphasise that this construct is not indicative of personality pathology. Although
guided by the work on disorders of self by Masterson and Klein (1989), where
pathological object representations are primary, the sensitivities are viewed as
dimensional, pertinent to all people. As Zanetti et al. (2011) note, “all parents fail to
provide protection and care sometimes, and all people develop some degree of defensive
exclusion” (p. 323), experiencing some needs and affects as safe and containable, and
others as unacceptable or painful. The core sensitivities are a translation of these
categories to understand relational functioning and defensive processes beyond the
extremes of psychopathology.

Cooper et al. (2005) propose that the gradations between sensitivity and personality
disorder result from the degree to which defences are rigidly and pervasively applied.
Sensitivities are theorised to range across a continuum from flexible and adaptive, to rigid
and pervasive. Masterson’s disorders of self represent the chronic use of particular
defensive strategies, where they have become a stable and fundamental part of the
individual’s personality structure. Particularly in the face of affect dysregulation, the
disorders of self are characterised by the inflexible use of a narrow range of responses.
Broadening this concept, the sensitivities reflect the characteristic ways in which

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individuals manage the need for both autonomy and relatedness, organised by
procedural memory. They are conceived of as predominant modes of affect regulation,
rather than singular and absolute rules for governing interactions. This re-
conceptualisation encourages the view that concerns in relationship and defensive
responses are relevant to all people to some degree. In the COS assessment process,
attention is paid to the flexibility-rigidity of the defensive process, the degree to which it
impacts upon reflective functioning, and how the parent’s sensitivity specifically affects
their representations of the child and interactions (Cooper et al., 2005).

Theoretically, each sensitivity is conceptualised as a less extreme, more flexible form of

each of the disorders of self: separation sensitivity in a pervasive and rigid form, may be
viewed as borderline personality disorder; esteem sensitivity, in an extreme form can be
seen as a narcissistic personality disorder; and safety sensitivity, rigidly held, can be seen
as schizoid personality disorder (Cooper et al., 2005). The shift to a more normative
model acknowledges the universal need for defensive protection against painful states of
mind. It encourages recognition that all people experience unregulated affect and are
reliant on strategies to manage this. Further, this reframe makes it possible to talk about
defensive processes with clients and work with them in understanding the impact of these
on their relationships. Perhaps most significant to this conceptualisation is that it
encourages empathy for the client’s pain, and the motivation for protecting against it
(Powell et al., 2014). Zanetti et al. (2011) suggest that this reframing serves to help
therapists recognise that all individuals are challenged in relationships, promoting a
stance of empathy and understanding. The core sensitivities provide a conceptualisation
of the motivation for utilising particular attachment strategies, and enable some
predictions or inferences as to the person’s characteristic defensive strategies, and when
these will become activated. Although one sensitivity seems to be primary for each
person, individuals nevertheless appear to demonstrate some measure of each strategy
at different times (Powell et al, 2014). The three sensitivities are introduced below, with
the core features summarised in Table 1.

Prototypes of the Core Sensitivities

Separation sensitivity. Corresponding to Masterson’s (1981) concept of the borderline

disorder of self, separation-sensitivity is characterised by a concern that being separate
or individuating from the other precedes abandonment (Powell et al., 2014). The
individual believes that they must disavow their own needs, wants and feelings in favour
of the other’s needs and goals in order to avoid rejection and maintain the relationship.
The struggle for a person who is separation sensitive is independence and hierarchy.
Separation sensitivity is characterised by vigilance to signs of distance in the relationship,
and a preoccupation with whether the other person is available and loving enough
(Powell et al., 2014). Strategies developed to maintain closeness to others may include
compliance, helplessness, intensification of need, and pressure to reassure or support
the self. In terms of parenting, the separation sensitive parent is challenged by the child’s
individuation or separation. They may fear that the child’s moves towards exploration and
autonomy signal abandonment or separation from their child, and thus they avoid

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interactions that encourage the child’s independence or distance between the caregiver
and child. As a result, the caregiver may discourage exploration, or individuation, while
fostering closeness and dependence. This may have implications for the caregiver’s
capacity to take charge in the relationship, as limit setting may be experienced as conflict,
and potentially associated with separation. Similarly, being able to be ‘bigger and
stronger’ in the face of a child’s dysregulation can be challenging for parents who are
separation sensitive. The need to establish hierarchy and follow through in asserting rules
and consequences requires self-activation, thus individuation, and may be experienced
as threatening to the relationship (Powell et al., 2014).

Esteem sensitivity. Esteem-sensitivity is predicated upon a belief that it is recognition for

performance and achievement that makes one worthy of connection to others, or worthy
of love (Powell et al., 2014). Corresponding to Masterson’s (1981) narcissistic disorder of
self, to protect from abandonment, the individual believes it is necessary to demonstrate
success and be special. To elicit recognition from others is to retain acceptance and
protects against the doubt that they are unworthy or inadequate (Powell et al., 2014).
Strategies to maintain a sense of specialness and self-worth include grandiosity, striving
for achievement and perfection as well as fusion with others, or one-mindedness. Esteem
sensitive persons are vigilant to signs of criticism and disagreement, and are particularly
sensitive to others’ perceptions of them. Vulnerability, and acknowledging mistakes and
imperfections, are painful. Disagreement is experienced as a break in fusion, and may
signal imperfection. For parents who are esteem sensitive, the child’s distress and need
for connection may be perceived as vulnerability, and a signal of the parent’s
incompetence, that may lead to criticism and rejection. The parent may dismiss the child’s
needs for closeness and comfort and encourage competence; placing greater emphasis
on exploration and achievement (Powell et al., 2014).

Safety sensitivity. Safety-sensitivity is exemplified by a primary concern with the danger

of being close to another. Concerns with engulfment or of being overwhelmed by the
needs and demands of the other are primary. Defensive strategies of avoidance of
intimacy and dampening of the intensity of emotional expression enable the individual to
feel a greater degree of safety. However, this comes at the cost of isolation, which can be
as equally intolerable as the sense of engulfment that comes with intimacy. The safety-
sensitive individual is vigilant to signs of intrusion or control from others, and attempts to
manage this experience through distance. The safety-sensitive parent may feel
threatened by the child’s bids for closeness and intimacy. The intensity of a child’s
emotion or need may be terrifying to the parent, who feels that their own sense of self
may be challenged or overwhelmed by the needs of the child. Therefore, their caregiving
may encourage the child to be self-sufficient, particularly in relation to regulating intense
emotions (Powell et al., 2014).

Table 1 Prototypes of the Core Sensitivities, adapted from Cooper, Hoffman & Powell,
2014

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Characteristic Separation Esteem Sensitive Safety Sensitive
Sensitive

Overall Afraid of Afraid of rejection; Afraid of being

Attachment separation; avoids avoids vulnerability and controlled;
Theme distance need avoids closeness

Goal of To maintain To enhance sense of A safe

Primary closeness by being self via perfection and compromise
Defense needy and/or admiration between
(seeks) needed closeness and
distance

Goal of Separation from Criticism, feelings of Loss of self

Primary others; acting on inadequacy, associated with
Defense one’s own behalf imperfection closeness;
(avoids) isolation

Unwanted Aloneness; Fragmentation, Engulfment; exile

Affect abandonment humiliation, shame, and isolation
emptiness

Vigilant to Availability of Devaluation, criticism, Safety; Isolation

other/abandonment attacking, judgment. or control and
misappropriation,
intrusion, intense
emotion

Primary Clinging; Grandiosity; Self-sufficiency;

Defensive Dependency; Entitlement; partial
Strategies Helplessness; Performance and/or attachment;
Compliance; Perfection; Seeking and fantasy as safe
Hyperactivation of demanding agreement relationship;
need withdrawal

Attachment If I focus on what is To need another is a If I let another

Distortion and in my best interest sign of weakness; if close, he or she
Core in the relationship, I there is disagreement, will overwhelm
Defensive will be abandoned. then I am wrong, or the me or control
Decision Separation is not other is wrong. Need is me. Closeness is
safe not safe; difference is not safe
not safe

Other ‘White knight’, Perfect, special, Safe, respectful

representation source of warmth, omnipotent, adoring, of boundaries,
(Positive) acceptance, adored accepting of self-
powerful, rescuer sufficiency

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 Other Abandoning, Disappointing, Smothering,
representation withholding, harsh, imperfect, cold, controlling,
(Negative) punitive, unfair, rejecting depriving, cold,
angry, unavailable indifferent.

Self Needed, always Wonderful, special, Safe, self-

representation available, perfect, fully sufficient,
(Positive) protected, caring, understood. independent,
supportive. quietly
understood.

Self Hopeless, helpless, Fragmented, ‘Slave’;

representation abandoned, humiliated, flawed, controlled;
(Negative) without resource. empty, alone with smothered or
shame lost in exile,
unable to
communicate or
connect

Primary I cannot be myself To get close is to be To seek

Dilemma and truly expect rejected; to truly closeness is to
connection. If I am separate is to be be taken
myself, I will be rejected. advantage of; to
abandoned. separate is to be
left in isolation.

Unspoken Intense pressure to Intense pressure to be Intense pressure

Demands be rewarded for acknowledged for for safety and
Placed on neediness, specialness, non-
Others helplessness and performance, perceived intrusiveness.
incompetence entitlement.

Note. These sensitivities are a reformulation of Masterson and Klein’s disorders of self,
with Separation originating from the Borderline Disorder of Self, Esteem from the
Narcissistic Disorder of Self, and Safety from the Schizoid Disorder of Self.

An understanding of an individual’s attachment pattern summarises the cognitive and

behavioural patterns that the individual draws upon to regulate distress and maintain
connection. It does not however, elucidate the particular moments or circumstances that
will activate this distress (Powell et al., 2014). It is the concerns or anxieties that lead to
particular attachment patterns or defensive styles that can be better understood through
the framework of the core sensitivities (Powell et al., 2014). For example, a safety-
sensitive parent with a dismissing attachment state of mind may emphasise the child’s
exploration and achievement, because to engage with the child during times of distress
threatens the parent’s own sense of self, activating fears of engulfment or of being
overwhelmed. An esteem-sensitive parent may also be dismissing with respect to
attachment, and may avoid emotional distress because they see it as vulnerability or

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weakness, which for the parent, has led to rejection or abandonment in the past. The
child’s need signals potential for vulnerability or imperfection. A separation- sensitive
parent may be unresponsive to emotional distress because they see it as a demand for
parenting that they do not feel competent to meet. They struggle to self-activate and
provide the necessary parental soothing, as a means of avoiding differentiation. It is the
nature of the events, affects, and interactions that activate distress or anxiety that is
conceptualised through the core sensitivities. Parents with the same attachment
classification may have different core sensitivities, and parents with the same sensitivity
may have different attachment classifications. Nevertheless, there appear to be some
links between the sensitivities and attachment states of mind, although research has not
yet been conducted on this. Those who are safety-sensitive or esteem-sensitive appear
to be more likely to be dismissing with respect to attachment, whereas separation-
sensitivity appears to be more closely linked with preoccupied states of mind (Powell et
al., 2014). Of importance, all three sensitivities can have secure attachment relationships
with their children.

Although developed specifically with COS in mind, the use of core sensitivities in
caregiving relationships is a focal application of a broader concept. The grounding in
personality theory, developmental processes and Masterson and Klein’s (1989) model of
therapy makes the constructs directly transferable to individual psychotherapy. The
constructs provide a valuable means for understanding interpersonal and intrapsychic
processes, and together with the more recent research from attachment theory and
affective neuroscience can guide both the content and process of therapy. Given that
“unarticulated experience is . . . often where we find the greatest leverage for therapeutic
change” (Wallin, 2007, p.115), models that enable the therapist to conceptualise
procedural knowledge that underpins patterns of behaviour and thinking are of particular
value. The case formulation and therapeutic models provided by McWilliams (2004; 2011)
and Young and colleagues (Young, Klosko & Weishaar, 2003) are exemplars of this
approach. Such frameworks enable the therapist to conceptualise the characteristic ways
in which the client processes and perceives experience, and the habitual patterns for
managing painful affects (state of mind) (Powell et al., 2014). Understanding the client’s
state of mind enables the therapist to attune to the predominant expectations and
experiences the client has based on these internalised models of self and relationship. In
turn, this may allow the therapist to predict and understand the types of affective and
relational experiences that may activate defensive responses, the types of defenses that
may be adopted and the behaviours and themes that may arise in the therapy (Fonagy,
2001).

Further, as in the COS, a formulation of an adult’s core sensitivity may provide specific
targets for intervention, providing a way to conceive of the aspects of the individual’s own
experience that are a source of pain, and the strategies developed to defend against
these. Although Masterson was particularly interested in the extremes of personality
pathology, his clinical interventions were directed towards supporting the client to activate
and respond to needs of the self that had previously been relinquished. For example,
when working with a person with a borderline disorder of self, the focus of intervention is

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on promoting self-activation. Correspondingly, in the core sensitivity of Separation
Sensitivity, themes of self-activation—acting in the interests of the self—and developing
comfort with autonomy would remain areas of therapeutic interest. They may be directly
the focus of a therapy, or at least guide the therapist as a dimension to attend to in
managing the therapeutic focus.

The value of the core sensitivities for the treatment of individuals who do not have more
extreme personality pathology may well lie in this tailoring of interventions for client
symptoms (in treatment of depression for example) by taking into account an individual’s
defensive style. Awareness of client defensive style and accurate tailoring of therapist
response to this is likely to lead to a more parsimonious therapy. That is, the therapist and
client are likely to spend more time able to focus on core issues for the client within their
window of tolerance for working with their particular vulnerabilities, as articulated within
the understanding of sensitivity. One further benefit of this is potentially in assisting the
management of therapeutic ruptures. This awareness of each client’s area of vulnerability
once considered through the lens of the core sensitivities, allows the therapist to both
recognise and proceed effectively to the resolution of ruptures in the treatment alliance.

Conclusion

The core sensitivities are a reconceptualisation of Masterson’s (1976; Masterson & Klein,
1981; 1995) psychodynamic work on the disorders of self. The shift to a more normative
model acknowledges that universal need for defensive protection against painful states of
mind. It encourages recognition that all people experience unregulated affect and are
reliant on strategies to manage this. Further, this reframe makes it possible to talk about
defensive processes and work therapeutically with them. Within the field of
psychotherapy, the constructs provide a valuable means for understanding interpersonal
and intrapsychic processes. A formulation of an adult’s core sensitivity may provide
specific targets for intervention, providing a way to conceive of the aspects of the
individual’s own experience that are a source of pain, and the strategies developed to
defend against these. Further, this formulation may guide the therapist in responding to
client defences, and in understanding their impact on the client. Taking these into account
in conceptualisation may promote therapeutic outcomes by improving quality of the
working alliance, facilitating shifts in affect regulation and supporting the therapist’s
attunement to the client’s relationship needs. It is our hope that this article promotes a
greater awareness and development of these ideas in the field of psychotherapy.

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