Core Problem Analysis and Three Core Senses

Everything is dialectical, which means that everything has two sides that are complimentary, such as night/day, black/white, life/death, good/bad, ying/yang, etc. These contradictory sides coexist and can be acknowledged simultaneously. Without embracing dialectics, we are bound to be stuck in one-sided, black-and-white perspectives, that lead to the attachment to outcome and rigid, ineffective decision-making.1, 2, 3, 4, 5, 6, 7, 8, 9 To embrace more nuances and flexible approaches, we need to learn to live in dialectical balance. Upholding dialectical balance means acknowledging the opposing forces in any situation, remembering that these sides are not mutually exclusive but instead parallel each other, and constantly looking for ways to integrate contradictory perspectives.

Conditional and Unconditional Sides of our Existence

Our very existence is dialectical, consisting of conditional and unconditional sides that function alongside but separately from each other. On the conditional end of the spectrum, we have our relationship with our environment – our thoughts/feelings/actions, ups/downs, wins/losses, mistakes/achievements, proud moments/disappointments, criticism/reinforcement from other people, etc. On the unconditional side, we have our relationship with Self – such as that to an entity. The dialectical synthesis of these opposing sides is: We just are, neither good nor bad (the unconditional side) AND our responses can be effective/ineffective, given a goal (the conditional side).

When a relationship with Self becomes conditional on life events (e.g., “I achieved, therefore I am good or I failed, therefore I am bad”), our existence becomes one-sided. Once a dialectical balance is disrupted, a person’s self-image starts to vacillate, depending on circumstances, between being positive and negative on a daily, and sometimes hourly, basis. This vacillation causes suffering, and a person gets stuck in attempts to artificially reduce the fluctuations of life by 1) avoidance of the challenges of daily living and/or 2) force, which includes attempts to change other people and/or punish Self for “being bad.” 

There are many reasons why our relationship with Self may transition from unconditional to conditional. Unfortunately, it does not take much to start this process. Simply saying “good girl or bad girl,” following a child’s response, merges the relationship with Self with achievements and failures. Further, harmful invalidation, specifically in early life, facilitates this transition to a significant degree.10, 11, 12, 13, 14, 15, 16 Harmful invalidation includes criticism, judgment, comparisons, shaming, blaming, insulting, forcing, imposing, etc. Harmful invalidation provides feedback on the level of the response AND on the personal level. It communicates that both – the response and the person – are “not good enough” and that the maladaptive response is proof that the person is “defective.” 17, 18, 19, 20 Thus, “who I am” starts to integrate with “what I do/feel/think.”

Through this transaction between our Self and the harmfully invalidating external world, our relationship with the environment becomes dysfunctional. Learning sustained from such a transaction is likely to result in interpersonal difficulties and in the acquisition of dysfunctional ways of dealing with stressors (e.g., avoidance, drug/alcohol use, suicidality, NSSI, verbal/physical aggression). The resulting maladaptive coping patterns are not problems themselves, they are solutions to problems, albeit ineffective ones.21, 22, 23 What is the problem that gives rise to these symptoms? The answer is – the dysfunctional relationship with Self, namely clinical levels of vulnerability in the core senses of self-love,24, 25, 26, 27, 28, 29, 30, 31, 32, 33 safety34,35, 36, 37, 38, 39 and belonging.40, 41, 42, 43, 44, 45, 46, 47  

Sense of self-love (SSL) is a stable and enduring ability to connect to self-love as is, without conditions or requirements. SSL is not the same as self-love, which is an instinct of self-preservation, an innate drive to care for one’s own well-being and protection.48 In crises, our love for Self gives us extra motivation (that can be experienced as thirst for life) to be able to overcome significant life-challenges (e.g., war, captivity, loss of loved ones) that otherwise can crumble us with hopelessness and helplessness.49 However, even instincts can break down, as we can hate ourselves enough for the instinct of self-preservation to crumble, resulting in self-harm and suicidality.

SSL refers to an ability to connect to self-love at will, regardless of life circumstances. The ability to connect to self-love is critical to establishing a relationship with Self as of that to an entity, neither good nor bad, where experience of self-love is not based on satisfying a requirement of being “good enough.” SSL allows a person to appreciate and enjoy one’s own abilities, inborn aptitudes, talents and inclinations, as well as acquired facilities, interests, competencies, expertise and mastery, as opposed to attempts to self-define or satisfy standards imposed by the environment. The primary function of SSL is to maintain safety via the drive for achievement, learning, self-expression, creativity, self-actualization, and the ability to practice the non-attachment to outcome. This concept cannot be practically embraced if the relationship with Self is conditional and is based on how one fares in life and the quality of their relationships with other people. Indeed, how can one practice the non-attachment to outcome, if their relationship with Self depends on this outcome?

Unfortunately, the information field in which we exist programs us to think of self-love as being selfish. Google search is an excellent way to learn about our collective knowledge, beliefs, prejudices, etc. This is what Google offers for synonyms to self-love: egocentricity, egomania, narcissism, self-absorption, self-centeredness, self-importance, vainglory, vanity, pridefulness, arrogance, egotism, etc. Thus, we are programmed to treat self-love as an undesirable quality, while we are expected to be loving to others. This combination of expectations is nonsensical, as we can only give to others what we have ourselves, and if we are not experiencing self-love, we cannot offer love to other people.50

However, despite this environmental programming, we still seek connecting to self-love as this is a biologically pre-programmed need – environmental programming (i.e., what we can call “software”) cannot override innate biological programming (i.e., hardware). Self-love becomes very loud when the instinct of self-preservation kicks in, however, between crises, self-love is dormant and it is hard to feel, just like most of us cannot feel our heart beating in resting states. For us to feel our heart beating we need to do sit-ups or consciously decide to experience it by putting a hand on our chest. Similarly, between crises we need to consciously decide to connect to our self-love in a particular way to experience it. We are not taught how to connect to self-love at will, instead we are programmed to assign conditions of “good-enoughness” that we need to satisfy to experience it (e.g., becoming smart enough, thin enough, successful enough, loved enough by others, etc.).

Thus, we are programmed to assign conditions to achieve something that is unconditional. Further, instead of using our SSL as a drive that naturally promotes our creativity, self-actualization, achievements, etc., we are attempting to use achievements to promote our connection to self-love.

Since it is impossible to achieve connection to self-love by satisfying conditions, we continue to fail. This results in self-criticism, self-judgment, self-blaming, self-shaming and attempts to do even better to finally become “good enough,” leading to further failure, dissatisfaction and shame. This vicious cycle of striving and failing destroys the stability of our unconditional relationship with Self, as of that to an entity, neither good nor bad.

Further, SSL is not synonymous with pride, self-esteem, self-confidence, self-care, self-actualization and the like. The latter constructs belong to a conditional side of the existence, as they are based on the “if-then” contingency (e.g., “I feel proud because I solved this problem”). Self-love, on the other hand, is unconditional (i.e., “I just am and I can always experience my self-love because I was born with it, just like I was born with my heart beating’). Self-love is a gift, not an accomplishment. That means that we do not have to become anyone, possess anything, attain anything and nobody needs to love us – in order to connect to our self-love. We just need to learn how to do it. Of course, we need achievements and possessions, and we need other people to love us. But we require those aspects of life for our relationships with the external environment; we do not require them for our relationship with Self.

There is a dialectical balance in the conditional and unconditional aspects of the two types of relationships – relationship with Self and relationship with others. Our relationship with Self is not conditional on our relationship with other people (even though we are programmed to believe so). However, our relationship with other people is conditional on our relationship with Self, as we do to others what we do to ourselves. For example, if I am self-critical, I will be critical and judgmental of others and I will tend to interpret what they say as criticism, regardless of their intensions. If I have pain inside, I will spread pain. If I have joy, I will spread joy.

Parental unconditional love for the child and radical acceptance of their child’s responses form a foundation for the child’s ability to experience self-love.51 On the other hand, pervasive and indiscriminate invalidation interferes with a child’s ability to experience love for Self.52, 53, 54, 55 It is hard for the child to even appreciate that self-love is possible if they believe that they cannot garner the love of their own parents, who are supposed to love their child just because this child exists. One of the aspects that may signal to a child that they are not loved unconditionally is parental “shoulds.” It is imperative for parents to avoid getting stuck in a picture of what the child “should” be and attempts to mold the child into their own shape and image. We all come pre-programmed in the shape and image of God, universe, nature (whatever one believes in). We can call this pre-programmed “hardware” by the analogy of our brain being a biological computer. This hardware contains talents, learning differences, traits, characteristics, predispositions to physiological and psychological disorders, etc. Another metaphor that we can use here is Michelangelo’s David, as every one of us is a wonderful piece of art. Unfortunately, parents frequently treat their children as simple blocks of marble that they need to shape into Davids. So, with the best intentions in mind, they take a chisel and a hammer (so to speak) to sculpt this “block of marble” in their own shape and image, which can only result in crushing the already existing David. Instead, they need to appreciate that they are entrusted to see that David in their child, love that David unconditionally and help their child see their David, love their David in themselves and self-actualize their David.

The inability to accomplish these tasks may result in the child becoming self-critical, self-hating, striving to attain “good enoughness”, failing to self-actualize own talents, allowing other people’s definitions of Self or imposing self-definitions, etc. This self-judgmental stance destroys the relationship with Self and, therefore, also causes major problems in their relationships with other people.

Sense of safety (SS) refers to an ability to self-control and accumulate resources, knowledge, and connections sufficient to handle challenges, as well as develop a realistic appraisal of danger. SS is not the same as safety, which we cannot assure. Indeed, we cannot control other people, life and circumstances. Further, this world is very unpredictable and sometimes even dangerous. So, for us to be able to venture into this uncontrollable, unpredictable and dangerous world, to effectively navigate it, to face challenges and to solve problems, we need to develop a sense of safety.

For example, connecting current SS to its roots, we would need to have enough SS to get out of a cave to hunt a mammoth, which is a very unsafe endeavor. Otherwise, we would stay in the cave and starve to death. SS entails: 1) the ability to control the only thing that we can – ourself (i.e., what I do/feel/think/biology); 2) having resources for hunting (e.g., pikes, spears); 3) having knowledge about mammoths (e.g., their patterns of reactions, typical behaviors, usual grazing areas) and skills necessary for effective hunting; and 4) being connected to a group of hunters (i.e., know own place, be willing to support others and establish a trusting relationship).

The primary function of SS is to increase chances of survival of an individual and as a species. Attaining and maintaining safety is a drive behind every aspect of life, including procreation, attainment of self-control and accumulation of resources, knowledge and connections. SS starts to develop within a secure environment, where caregivers provide stability, protection and consistent support. SS continues to develop when a child acquires better control over their own responses and accumulates life experiences to trust their ability to effectively deal with life challenges.

SS may not properly develop when an environment is unpredictable, sometimes responding effectively to the child’s needs and sometimes not, pervasively invalidating their child’s abilities to handle internal and external events and frequently accommodating maladaptive responses. Failure of the environment to provide consistent protection and support interferes with the child’s ability to trust self, others and the world, and to develop self-control.56, 57, 58, 59

SS requires stability, predictability and control. We are all very busy attaining and maintaining control, whether or not we consciously understand this (e.g., entering into arguments, insisting on being right, following rules or routines rigidly, fighting about who gets a bigger slice of pizza, retaliation, perfectionism, throwing outbursts to get attention, using silent treatment, punishing a child, self-harm, anorexia, compulsions, emotional inhibition, threatening suicide, risk aversion, avoidance, social isolation, any verbal and physical abuse, etc.). The need to exercise control is evident from early childhood. The first word of a toddler is usually “mama,” the second word is typically “papa,” and the third word is ‘NO!” No is a word of control and a barely talking and walking tiny human being is already attempting to exercise it because it is pre-programmed for our safety.  If a child does not learn how to exercise this control in a healthy way – by controlling self, this child will attempt to get an illusion of control by attempting to control other people (e.g., verbal/physical aggression, destruction of property, threats of suicide) and/or will attempt to control Self in maladaptive ways (e.g., self-criticism, self-punishment, self-harm, suicidality, substance/alcohol use).60, 61

Actual ControlIllusion of control
Internal locus of controlExternal locus of control
Taking responsibility to own reactionsMaking others responsible for own reactions
Self-control, self-reinforcement, self-validation, self-compassion, self-reprogrammingUsing force with Self (e.g., self-criticism, self-harm, suicidality, self-punishment)
Directly influencing own responses to indirectly influence other people’s behaviors (e.g., acceptance, validation, shaping, ignoring, reinforcement, modeling adaptive behaviors)Using force with others to obtain compliance (e.g., threats, criticism, shaming, blaming, interrogating, insulting, punishing, using silent treatment, verbal/physical aggression)

Sense of belonging (SB) refers to an enduring sense of being welcomed, valued, supported and accepted as a part of a family or a group, as well as connection to ancestry. It is not the same as belonging, which is not guaranteed and cannot be forced.  The primary function of SB is to maintain safety via the drive for affiliation and congregation, attachment, affinity, empathy, care, support and love for other people.

Everything is dialectical, including our innate programing. To counterbalance our need for control, which is a drive to “divide and conquer,” nature pre-programmed an innate benevolence, which is a drive to “support, care and attach.” Without a pre-programed need to affiliate, humans would not be able to survive in groups.62, 63

SB starts to develop within a family, through a positive relationship with caregivers. A relationship where parents frequently use downward comparisons and are critical, judgmental, retaliatory, invalidating, punishing and dismissive is likely to communicate messages to the child that she is not good enough, not accepted and even not wanted.64, 65, 66

While SSL and SS are primarily about the relationship with Self, SB incorporates both – relationships with Self and with others. A healthy relationship is based on giving. To be able to give to others, one needs to first satisfy one’s own needs. There are two main ways in which we can satisfy our needs – taking from others and giving to ourselves. The information field in which we exist mostly teaches us to be self-critical and rely on other people for reinforcement, validation, care, support, love, etc. We are even taught, through modeling (i.e., observing other people blaming each other and even children for their own failures, disappointments, bad mood, verbal/physical aggression, etc.), to put responsibility on others for our own reactions, thus putting them in control of our lives. For example, “If you had not said this, I would not be angry” or “If only you did what I asked, I would not have screamed at you.”

Unfortunately, we are not taught to reinforce, validate or even love ourselves. How many people do you know who were taught by their parents to simply self-reinforce? How many people were taught to self-validate? How many people do you know discussed self-love with their children? Even worse, we are programmed to equate self-love with being selfish, unduly vain, narcissistic, or conceited, as we discussed above. Thus, we are mostly programmed to be takers and when others fail to satisfy our needs, we are likely to retaliate and use force to get what we want via threats, screaming, yelling, accusations and sometimes even violence. A simple example of this is a child who becomes verbally and physically aggressive, as a result of not getting what they want.

Instead of relying on others, we need to learn how to give to ourselves and then teach our children how to give to themselves. Of course, as we give to Self, we still need to receive from others. We always have to balance two sides, including satisfaction of our own needs. Of course, receiving from other people praise, validation, love, etc. results in an experience with higher emotional intensity than when we self-reinforce or self-validate or sit with self-love. Therefore, receiving from others can be compared to “getting a cake.” Giving to self, on the other hand, does not result in experiencing such intense emotions, so we call it “baking our own bread.” As always, there are two sides to everything – “getting a cake” from others is more exciting AND we are not in control of this outcome; while “baking our own bread” is not as exciting AND we are in control of this process.

“Baking Your Own Bread ingredients”
Self-love
Self-care
Self-control
Self-validation
Self-compassion
Self-reinforcement
Cognitive self-restructuring

So, to sum up, two main considerations on why learning to give to self is imperative: 1) we can assume control over the satisfaction of our needs; and 2) we can gain a capacity to form and maintain healthy relationships with other people.

The three core senses themselves are in a dialectical balance, as SSL is fully unconditional (i.e., we can connect to self-love at will, as we are born with it), SS is fully conditional (i.e., we are not born with self-control and have to achieve it, as well as accumulate resources, connections and knowledge), and SB is both (i.e., unconditional in terms of being born to a family and ancestry that we did not choose and conditional in terms of building our own families and relationships with friends).

Conditional side of existenceUnconditional side of existence
Relationship with the external environmentRelationship with Self
Responses (emotions/thoughts/actions/biology)I am an entity
Win/lose; angry/happy; others love me/hate mePeace with self (I am neither good/nor bad)
Sense of safetySelf-love
Sense of belonging (own family and friends)Sense of belonging (parents, ancestry)

Core Problem Analysis (CPA) stipulates that a primary function of all responses (adaptive and maladaptive) is to decrease vulnerabilities in the core senses (responses also have secondary functions, such as coping, attention, retaliation, instrumental, etc). Maladaptive responses function to decrease vulnerabilities in core senses in the short-term, while increasing them in the long-term (just like self-harm helps to decrease emotional arousal in the moment, while causing more problems for the future). Adaptive responses, on the other hand, may increase vulnerabilities in the core senses in the short-term, while decreasing them in the long-term (just like facing a challenge can be difficult in the moment and improves our capacity to skillfully solve problems in the future).

What is Core Problem Analysis?

CPA is an assessment and intervention model. As an assessment method, CPA examines vulnerabilities in the three core senses by using Socratic questioning and a modified CBT downward arrow technique to: 1) understand interpretations people construct about events; 2) evaluate how these interpretations contribute to the development and exacerbation of vulnerabilities in the core senses; and 3) examine how maladaptive responses function to decrease these vulnerabilities in the short-term, while increasing them in the long-term.

Furthermore, CPA-specific interventions aim to: 1) improve the relationship with Self; 2) decrease vulnerabilities in the core senses in the long-term; and 3) restore the dialectical balance via achieving a synthesis of “I just am, AND I can be happy/disappointed with my responses and how others relate to me.”

  • For SSL, CPA includes interventions to achieve the connection to self-love at will, regardless of life circumstances.
  • For SS, CPA includes interventions to improve the capacity to directly influence one’s own responses.
  • For SB, CPA includes interventions on how to satisfy one’s own needs. Only through giving to Self, can one then give to others, which is the foundation of healthy belonging.

CPA adopts a position of synthesis between 1) the strictly behavioral approaches, where responses are proposed to be mostly controlled by environmental factors, and 2) the strictly dynamic approaches, where responses are proposed to be mostly influenced by unconscious processes. CPA allows examination and targeting of factors that are external and internal, and includes assessment of conscious processes, as well as material that is not on the level of awareness.

CPA has been derived from clinical work with children, adolescents and adults with severe emotional and behavioral dysregulation, as well as from working with their families. The development of CPA was a bottom-up process, as it did not start with conceptually derived three core senses. As Dr. Perepletchikova was conducting functional analyses of her clients’ maladaptive responses, she noticed a pattern, namely, regardless of a response, every analysis landed on an issue with “good enoughness,” and/or lack of control and/or fear of being alone or rejected from a group. These notions were later conceptualized as core senses of self-love, safety and belonging, respectively. CPA has been evaluated as a part of an experimental intervention in an RCT of DBT-C.67

CPA is a transdiagnostic model, as there is a function behind every dysfunction. It has been used with children as young as 4 years of age, adolescents, and adults. CPA can be integrated into standard DBT and other therapeutic approaches as an assessment and intervention tool.

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