Understanding Psychotherapy Change: A Practical Guide to Configurational Analysis

150 Pages·2005·6.357 MB·English

by  Mardi Jon Horowitz M.D.

UNDERSTANDING
PSYCHOTHERAPY
CHANGE
Understanding Psychotherapy Change: A Practical Guide to Configurational
Analysis, by M. Horowitz
Copyright © 2005 American Psychological Association. All rights reserved.
UNDERSTANDING
PSYCHOTHERAPY
CHANGE
A PRACTICAL GUIDE TO
CONFIGURATIONAL
ANALYSIS
MARDI HOROWITZ
American Psychological Association • Washington, DC
Copyright © 2005 by the American Psychological Association. All rights reserved.
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Psychological Association.
Library of Congress Cataloging-in-Publication Data
Horowitz, Mardi Jon, 1934-
Understanding psychotherapy change : a practical guide to configurational
analysis / Mardi Horowitz.
p. cm.
Includes bibliographical references and index.
ISBN 1-59147-228-8
1. Psychotherapy—Methodology. I. Title.
RC480.5.H673 2005
616.89'14—dc22 2004021053
British Library Cataloguing-in-Publication Data
A CIP record is available from the British Library.
Printed in the United States of America
First edition
For my grandchildren (so far),
Wesley, Paloma, Jack, Elijah, Leilani, Ari, and Lahela.
CONTENTS
Foreword ;x
Preface XL
Introduction 3
I. Case Formulation 15
Chapter 1. Janice's Case and Steps 1 Through 4 17
Chapter 2. Steps 1 and 2: Describing Phenomena and
States of Mind 27
Chapter 3. Step 3: Formulating Topics of Concern
and Defensive Control Processes 47
Chapter 4. Step 4: Exploring Identity and Relationships 55
II. Mid-Course Corrections 69
Chapter 5. Steps 5 and 6: Modifying States and State
Transitions and Working Through Topics
of Concern 71
Chapter 6. Step 7: Working on Views of Self
and Relationships 87
III. Evaluation and Treatment Outcome 99
Chapter 7. Step 8: Evaluating Change 101
Chapter 8. Review of Configurational Analysis 113
vu
Epilogue 119
Glossary 121
References 125
Index 133
About the Author 139
viii CONTENTS
FOREWORD
JEROME L. SINGER
In the mid-1930s, a young American psychologist, Saul Rosenzweig
(deceased in 2004 at age 97), wrote to Sigmund Freud to describe his
experimental research with normal individuals, studies that lent some sup-
port to the theory of repression. Freud wrote back to Rosenzweig thanking
him for his interest but pointing out that laboratory research could not
really contribute to the theory that was best derived from the clinical
psychoanalytical process. Somewhat condescendingly, Freud added, "But
there is little harm in your effort."
About 20 years later when I was one of the early psychologist candidates
admitted to a psychoanalytical institute, a famous analyst, Erich Fromm,
dismissed my comments about the necessity for research studying how emo-
tions interacted with basic cognitive processes in generating motivation by
calling such work "mere academic psychology."
Mardi Horowitz, from his earliest days in psychiatry, has been commit-
ted to integrating psychotherapy and psychoanalytical theory with the data
and constructs of fundamental behavioral science research on cognitive and
affective processes. His continuing interest has been in the conscious stream
of thought and its relationship to the unconscious mental processes that
seem to be illuminated by the clinical data of psychoanalysis. We first met
about 40 years ago when, as a young psychiatrist starting a research as well
as a clinical career, he visited the laboratory on consciousness and cognition
that John Antrobus and I had established at the City College of New
York. Horowitz had begun a series of important experimental studies on the
contingent circumstances that led particular stressful or traumatic experi-
ences to generate intrusive or peremptory ideation patterns into the flow
IX
of normal thought. He also pioneered the study of other constituents of
thought, especially visual imagery, which he showed to be especially relevant
to the psychotherapeutic process. The fine work he did integrating laboratory
research and clinical service undoubtedly accounted for his selection by
the Mac Arthur Foundation to direct their national research program on
conscious and unconscious mental processes. In the course of this decade
of combined laboratory and clinical studies he brought together for consulta-
tion, theory construction, and collaborative research some of the most gifted
cognitive scientists and psychodynamically oriented experimenters.
In many ways this volume reflects the influence of the rich research
outcomes of this impressive effort, winnowed through the particular combi-
nation of clinical sensitivity and broad scholarship that is Horowitz's special
gift. He has directed his effort in this book to examining how the linkages
between moods or states of mind, cognitive processing, motivations, and
the therapeutic alliance of client and practitioner can identify adaptive and
maladaptive role relationships and lead to effective change in personalities.
In these days when psychology and psychiatry may have veered too sharply
(perhaps under insurance company pressures) in the direction of a narrow,
traditional medical-model, symptom-reduction focus, he has drawn on re-
search evidence and clinical experience to support a more person-centered
and surely effective psychotherapeutic orientation. One finds in this volume
implications derived from cognitive science's research on schemas and scripts
as critical features of mental organization, from studies of self-schemas and
the discrepancies between actual and ideal self-descriptions conducted in
social psychology as well as from Horowitz and collaborators' own studies
of conscious and unconscious mental processes as they emerge in therapeutic
interactions. This solid underpinning of basic research is directed toward
the practical concerns and efforts of the committed clinician. In addition to
its solid basis in broad-ranging technical research, the material on producing
clinical change is presented in a clear and direct fashion. After a half century
of effort myself as a clinician and psychological scientist, I strongly urge
readers, whether practitioners or researchers, to study this book with care
and to apply what they can to an integrative scientist-practitioner effort
in the best tradition of mental and behavioral science.
FOREWORD
PREFACE
In this book, I present a systematic way to formulate the answers to
the following questions: What changes in psychotherapy are desirable? How
does change come about? What does change? The method is called configu-
rational analysis. I developed configurational analysis by integrating different
schools of thought about what happens in symptom formation and psycho-
therapy, taking the perspectives of both cognitive science and psychody-
namics. The result of these efforts was a book called States of Mind (Horowitz,
1979, 1987).
Each component of configurational analysis was revised and upgraded
through clinical research efforts that followed the publication of States of
Mind. These investigative methods were summarized in Person Schemas and
Maladaptive Interpersonal Patterns (Horowitz, 1991b). The emergent theory
was highlighted in Cognitive Psychodynamics: From Conflict to Character
(Horowitz, 1998). Configurational analysis was presented as a pragmatic
approach to initial case evaluation in Formulation as a Basis for Planning
Psychotherapy Treatment (Horowitz, 1997, 2002a). Since 1997,1 have ampli-
fied the system, resulting in the work presented in this book.
1 developed this material through years of teaching psychotherapy
beginners, so it is written at a level suitable for trainees. Although the
system has dynamic depth, allowing for inferences about not-so-conscious
motives, it is most sharply focused on what can be observed, including
defensive states. The system allows for understanding often complex emo-
tional issues, and it can be used as a basis for planning any kind of technique
or technical combinations. By learning this sytem trainees will acquire new
abilities to discern the subtle variations in the state of another person, as
well as themselves in the context of doing therapy. I also hope that some
readers will go on to study how change occurs, in different types of conditions,