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December 1972 - present
Publications
Publications (252)
Individuals who experience trauma or loss perceive a seriously altered world. Survivors must revise their mental models of identity and adapt to new circumstances. When emotional disturbances lead to a person seeking treatment, useful therapy techniques include efforts at developing new selfconcepts. A particular defense that can interfere with sel...
Emotional control may be observed to be (1) too excessive as in avoidant behaviors during psychotherapy, (2) suitable to a frank expression of feelings, or (3) lacking in regulation causing too intense affective experiences. This article offers a theory that may help clinicians make observations about this range of possible states, formulate the pa...
This book will expand your therapeutic repertoire. Once crises have been resolved, the clinician and patient explore what can change in order to increase the patient's capacities for balance, harmony and satisfaction. Adult personality growth increases self-awareness, amplifies capacities for realistic social cognition and reduces avoidances. The o...
Traumatic events lead to a variety of responses, including disturbances of conscious sensations that range from intrusive thoughts and images to emotional numbing. This brief report focuses on phasic alterations of self-identity experiences, using two case examples from psychotherapy. The vignettes clarify contemporary theory about how posttraumati...
Abstract This article addresses the complex issue of how to clarify conflicts involving value judgments. The author reviews his experiences as therapist, supervisor, and consultant in offering second opinions on in-progress therapies. He summarizes six major obstacles to effective value clarifications and interpretations. Therapists can help patien...
Abstract Grieving is a well-known topic to psychodynamic clinicians. Nonetheless, the identity disturbance and identity growth issues that accompany the familiar problems are less well known. Phases of modification of self-organization during an adaptive mourning process can be facilitated by helping patients with pathological grief clarify the shi...
Advances in science and the humanities have demonstrated the complexity of psychological, social and neurological factors influencing identity. A contemporary discourse is needed to anchor the concepts required in speaking about identity in present day understanding. In Identity and the New Psychoanalytic Explorations of Self-organization, Mardi Ho...
Discusses the term abreaction as a clinical phenomenon in which experiences of traumas are recollected, often after a period in which they have not occupied conscious attention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This review examines the question of whether there should be a cluster of disorders, including the adjustment disorders (ADs), acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and the dissociative disorders (DDs), in a section devoted to abnormal responses to stress and trauma in the DSM-5. Environmental risk factors, including th...
It is posited that over the next years civilian mental health professionals will encounter stress response syndromes in Vietnam veterans, will misread etiological factors, and will be unable to treat such persons effectively. This paper attempts to describe the types of problems which may be expected and suggests special approaches which will be re...
INTRODUCTION: The aim of the Impact of Event Scale (IES) is to evaluate subjective distress associated with life events. The instrument is not focused on a specific situation, but rather on the particular characteristics of such events. OBJECTIVE: To describe the translation and semantic adaptation of the IES into Brazilian Portuguese. METHODS: The...
Introduction: The aim of the Impact of Event Scale (IES) is to evaluate subjective distress associated with life events. The instrument is not focused on a specific situation, but rather on the particular characteristics of such events. Objective: To describe the translation and semantic adaptation of the IES into Brazilian Portuguese. Methods: The...
Osteoblasts play a central role in the regulation of bone remodeling. Not only are they responsible for the formation of new bone, but they also regulate bone resorption. These cells also exert regulatory influences outside the bone in that they are able to regulate hematopoiesis. However, obtaining pure populations of osteoblasts devoid of contami...
Cytokines, a group of proteins known to regulate hemopoietic and immune functions, are also involved in inflammation, angiogenesis, and bone and cartilage metabolism. Since all of these processes occur following bone injury, or are known to contribute to wound repair mechanisms, this investigation sought to test the hypothesis that cytokines are in...
Ein Zugangsweg zur psychotherapeutischen Arbeit besteht darin, das eigene Wissen zu strukturieren und einzugrenzen. Der seit
mehreren Jahrzehnten verfolgte Ansatz des Autors beschränkt sich innerhalb der Störungen ai]f die Belastungsfolgesyndrome
— und innerhalb der verschiedenen Persönlichkeitsstile ai]f den zwanghaften, den histrionischen sowie d...
Revenge fantasies can be an important component of posttraumatic stress disorders. Attention to them in therapy can help people adapt to their stress. The function of revenge fantasies, feeling good, makes them especially hard to give up, and this should be addressed by clinicians.
In
Understanding Psychotherapy Change: A Practical Guide to Configurational Analysis, Mardi Horowitz provides a simplified discussion of his empirically supported, integrative approach to case formulation. He begins by tracing the roots of this approach and its refinements and providing an overview of the process. Then, using an extended case exam...
Living with HIV can challenge core features of a person's sense of identity and ultimately lead to a diminished sense of self regard. Self-regard has been defined as the extent to which a person experiences an integrated sense of identity. Gay men with HIV may also face struggles related to their identity in deciding whether to disclose or conceal...
Psychological mindedness and mindfulness are common themes across schools of psychotherapy. A somewhat smaller construct can be better defined: self- and relational observational capacity. This article defines and assesses strategies for 3 components of self- and relational observation: (a) awareness of feelings, ideas, and emotional control; (b) a...
A one-year longitudinal study was conducted investigating the psychological effects of the news of genetic testing for the Huntington disease (HD) gene. Participants were assessed at baseline (before obtaining news of test results) and at three, six, and 12 months after test results on stress-specific symptom measures. Among carriers of the HD gene...
Previous findings on the role of expectancy of spousal death in adjustment to bereavement are inconclusive due to methodological shortcomings. This study examined the impact of subjective and objective expectancy on adjustment, while addressing the methodological problems of previous studies. At six months postbereavement, 97 midlife bereaved adult...
Clinicians need to recognize and respond to stress response syndromes that may occur after patients have received genetic testing for inherited susceptibility to serious diseases. For patients whose test results convey high risk, increased attention to prevention, surveillance, and early medical treatment may be possible, but the grim news may also...
The impact of object relations on adjustment in conjugal bereavement was examined. At approximately 6 months postbereavement, 46 midlife bereaved participants engaged in a narrative interview in which they were asked to discuss their past relationship with their deceased spouse. The Westen et al. object relations scoring system was applied to these...
Bereaved individuals who had lost a spouse through death (on average 7.2 months previously) engaged in an empty-chair monolog task in which they imagined that they had one last opportunity to speak to their deceased spouse. The verbal content of their monolog speech was rated by judges on the appraisal categories deceased as blameworthy and self as...
Previous findings on the role of expectancy of spousal death in adjustment to bereavement are inconclusive due to methodological shortcomings. This study examined the impact of subjective and objective expectancy on adjustment, while addressing the methodological problems of previous studies. At six months postbereavement, 97 midlife bereaved adult...
A semantic space perspective on representations of self and other was applied to investigate the perceived quality of the past relationship with the spouse in relation to adjustment in conjugal bereavement. According to this perspective, the proximity, or extent to which representations of self and others share similar trait content features, may h...
The role of continuing attachment in adjustment to conjugal loss was examined. At 6 months postloss, 70 midlife bereaved participants were interviewed to assess different forms of continuing attachment. They also engaged in a monologue role-play with their deceased spouse, providing a behavioral measure of grief-related distress. In addition, they...
Defensiveness in intrapsychic and interpersonal activities is a generally accepted concept among psychodynamic theorists, but a theoretically grounded classification of emotional control processes is needed. As a result of intensive case-by-case clinical and empirical studies, such a system was assembled. The system is organized by three major cate...
Using sequential analysis, the authors examined how therapists' actions related to the verbal disclosure and defensive patterns that followed therapists' interventions within a single therapy hour for 20 patients. At the same time, a new measure, the Psychodynamic Intervention Rating Scale (PIRS), was tested for reliability and construct validity....
A narrative coding system was employed to investigate the thematic parameters of complicated grief among participants who had recently experienced spousal loss. Two goals guided the research. First, we investigated the prevalence of and interrelationship between positive and negative themes in a narrative interview conducted 6 months into bereaveme...
Ambivalence is widely assumed to prolong grief. To examine this hypothesis, the authors developed a measure of ambivalence based on an algorithmic combination of separate positive and negative evaluations of one's spouse. Preliminary construct validity was evidenced in relation to emotional difficulties and to facial expressions of emotion. Bereave...
This study examined whether process variables predict an outcome of complicated grief. A turbulent and prolonged grief was predicted to occur after the death of a spouse in subjects who had self-blame, used the deceased for an extension of self, had ambivalence toward the deceased, or overcontrolled emotional responses. Ninety subjects were examine...
In this study the Gestalt empty-chair technique was applied in a research context to assess unresolved grief and its relation to later adjustment. Bereaved individuals who experienced the death of a spouse on average 6 months ago participated in an empty-chair monologue task in which they were instructed to speak to their deceased spouse, imagining...
Following critiques that the DSM multiaxial system lacks psychodynamic information useful for treatment, an axis for defense mechanisms was developed for DSM-IV, including up to 7 individual defenses from a glossary of 27, and 3 predominant defense levels from a list of 7. We tested the feasibility, reliability, and discriminability of the proposed...
Numerous studies have linked stress and negative states to adverse health outcomes. However, in addition to engendering negative states, stress may impair capacities to experience positive states. Such failure to experience positive states may represent a risk factor for poor health in and of itself. The research reported here examines a brief, eas...
Some prolonged and turbulent grief reactions include symptoms that differ from the DSM-IV criteria for major depressive disorder. The authors investigated a new diagnosis that would include these symptoms.
They developed observer-based definitions of 30 symptoms noted clinically in previous longitudinal interviews of bereaved persons and then desig...
Diagnosis by DSM-IV is seldom sufficient to the task of planning and conducting treatment by psychotherapy. Formulation is vital for the task. I have developed a formulation approach called configurational analysis, and usually employ this tool in my work with individual adult cases. However, in this paper, I have also applied it to an evaluation s...
The author uses a configurational analysis method for case formulation and to establish links between individualized formulation and treatment techniques. A prototype of formulation for the histrionic personality disorder is presented, using theories for formulation about states of mind, defensive control processes, and person schemas. A phase-orie...
This book presents theory and research on the stress response syndromes, including posttraumatic stress disorder (PTSD), grief, and adjustment disorders. Part I describes the investigations into the characteristics of stress response syndromes. Part II explains these general response tendencies and describes the principles of brief treatment for st...
The status of patients and research subjects is usually considered in terms of self-reported symptoms. Measures seldom include disturbances in a conscious sense of the self. An additional brief measure of the sense of current self-regard is desirable, since a conscious lapse in an integrated self-concept may occur under stressful circumstances. The...
Psychodynamic clinicians cite defensive actions observed in evaluation and treatment as a source of important information. Empirical support for such assertions has seldom been based on objective study of recorded psychotherapy. A quantitative study of the association of signs of defensive control with disclosure of conflicted beliefs was undertake...
The authors' objective was to develop a simple and reliable descriptive method for categorizing patient states during psychotherapy. The categories would be based on the degree of apparent control over emotional expressions. Methods involved scoring videotapes of psychotherapy for 5 patients with neurotic-level Axis I disorders. Three judges rated...
The predictive value of the network perspective on the content of person-concepts was investigated in two studies. A number of predictions were tested based on the positive relationship between person-concept feature centrality and accessibility derived from the network model. Consistent with a network account of person-concept feature centrality,...
Background:
Psychodynamic clinicians cite defensive actions observed in evaluation and treatment as a source of important information. Empirical support for such assertions has seldom been based on objective study of recorded psychotherapy. A quantitative study of the association of signs of defensive control with disclosure of conflicted beliefs...
It has been widely assumed that emotional avoidance during bereavement leads to either prolonged grief, delayed grief, or delayed somatic symptoms. To test this view, as well as a contrasting adaptive hypothesis, emotional avoidance was measured 6 months after a conjugal loss as negative verbal-autonomic response dissociation (low self-rated negati...
Personality disorders are important because they occur frequently and often complicate psychiatric symptom disorders. They are difficult to diagnose and formulate because unitary core traits and themes are hard to define for individual patients. A multiple-selves approach helps clinicians define core contradictions in belief that are frequently pre...
While content analysis of discourse has a rich history, relatively little research has been aimed at identifying topics by their content. In this paper we test the assumption that identifying the content and sequences of topics reveals clinically useful information about a person's mental structure, by studying change in the discourse structure ove...
Background:
Personality disorders are important because they occur frequently and often complicate psychiatric symptom disorders. They are difficult to diagnose and formulate because unitary core traits and themes are hard to define for individual patients. A multipleselves approach helps clinicians define core contradictions in belief that are fr...
This roundtable discussion focuses on psychotherapy research devoted to 2 central thrusts of the integration movement, namely common factors and technical eclecticism. The panel consists of prominent psychotherapists, active both in practice and research, who offer their recommendations concerning the concept and conceptualization of empirical exam...
Discourse of bereaved individuals talking about the deceased and other topics was examined using computer-based text analyses and judged ratings of verbal behavior for patterns indicating dysfluency and orientation toward topics. Using factor analysis, the discourse structure of low-distress bereaved individuals was compared with that of high-distr...
A semantic space model of mental representations of self and other was applied in a case study of pathological grief Traits and characteristics elicited on a questionnaire were used to elicit judgments of similarity of representations of self and important others to one another before therapy began, in the middle of therapy, and at the conclusion o...
Discourse of bereaved individuals talking about the deceased and other topics was examined using computer-based text analyses and judged ratings of verbal behavior for patterns indicating dysfluency and orientation toward topics. Using factor analysis, the discourse structure of low-distress bereaved individuals was compared with that of high-distr...
A quantitative study of shifts in states of mind was conducted to demonstrate a clinically useful mode of observation. This mode categorizes observations of a patient's mental state into well-modulated, overmodulated, undermodulated, and shimmering patterns.
The authors used reliable systems for scoring a patient's state of mind on videotapes of al...
Both psychodynamic and social-cognitive theoretical domains have control process models of behavior but with different ideas about the purpose and loci of control. This study examines expressive and defensive behaviors associated with different topics of discourse in the time-limited psychotherapy of a woman treated for pathological grief. Conceptu...
A major challenge in treating and studying mental disorders is achieving interclinician agreement about maladaptive intrapsychic and interpersonal patterns. Two teams independently constructed sets of psychotherapy case formulations following the Role Relationship Model Configuration (RRMC) method. Formulations were based on transcripts from the 1s...
To attenuate emotional responses to particular ideas and to avoid entry into dreaded states of mind, a person may avoid representation of topics that might otherwise usefully become the central focus of attention. Both conceptual avoidance and conceptual intrusion may result from the interplay of aims at representation and warding-off. In psychoana...
A common language is necessary for an integration of psychotherapy techniques. This means that each ‘brand name’ must surrender some historically used terminology. A modern cognitive language seems to be an acceptable ground. This paper suggests how a theory of states, schemas, and controls can use such a language while revitalizing dynamic concept...
A proportion of the people who sustain stressor events develop a variety of neurotic level reactions. Higher impact stressor events, more personal exposure, and cascading combinations of events increase the likelihood that exposed individuals will manifest distress. Certain personality features may also increase the disposition of individuals to de...
Configurational analysis is a system for case formulation that is especially useful in cases where maladaptive interpersonal patterns are an aspect of psychotherapy. The method is systematic and begins with description of signs and symptoms to be explained. These phenomena lead to inferences about states of mind, person schemata, conflicts, and pro...
Pathological mourning is such an excessive, blocked, or distorted process that psychiatric signs and symptoms develop. Explanation of how and why these signs and symptoms form could deepen an understanding of both normal and pathological mourning. Because many variables are involved in such explanations, intensive case study is a desirable methodol...
We present Psyclops, an interactive computer graphic system designed to help address a growing information dilemma in the examination of individual psychiatric cases. Ever more information is needed to better understand conscious experience, interpersonal behavior, and the formation of psychiatric signs and symptoms, yet the information load alread...
This single-case study examined frank disclosure of important topics in a brief exploratory psychotherapy, including topics closely related to a recent, unintegrated stressor life event. Quantitative measures of emotion and control variables showed heightened levels of both emotionality and defensive control during discourse on the topic of the str...
Pathological grief deserves a place in the diagnostic nomenclature. Because posttraumatic stress disorder requires an event beyond the range of usual experience and bereavement is virtually a universal experience, a new diagnosis of signs and symptoms precipitated by a loss event is needed. Many varieties of pathological grief have been noted in cl...
introduce . . . a new class of transference-related measures / these measures have in common a method for extracting from psychotherapy sessions the patient's underlying patterns of conflictual themes / almost all of these measures emphasize the central relationship pattern (CRP) of conflictual relationships with others and with the self (PsycINFO...
Elaboration and Dyselaboration are new measures for assessing emotional and defensive discourse. The measures can be applied to short segments and so may show the effects of shifts in the subject's state of mind within a session. The measures were reliable when scored on transcripts both from a single case in psychotherapy and from 30 cases in eval...
Recurrent patterns of maladaptive interpersonal behavior are usually a focus of attention in psychodynamic psychotherapy. Observing, describing, and explaining these patterns as enduring conflicts is part of the task of formulation. One approach to such formulation, the Role-Relationship Models Configuration (RRMC) method, infers roles of self in t...
Defense-mechanism theory and control-process theory are related psychodynamic approaches to explaining and classifying how people ward off emotional upsets. Although both theories explain defensive maneuvers in the same motivational terms, each defines categories different1y. Classic categories define defense mechanisms at a relatively macroscopic...
introduce readers to the persons who have shaped and are shaping the psychotherapy research enterprise / we asked them to provide a personalized account of their research careers—what they did, why they did it, what they found, and, perhaps most important, who they are / we have reports from twelve research centers / [these vignettes] reveal, to a...
Stress response syndromes lie between normal adaptive response to natural disasters and more severe forms of psychopathology that may be chronic or episodic, and worsened by exposure to the disaster. The most common psychopathological diagnosis is posttraumatic stress disorder (PTSD); however, depressive states, phobic disorders, reactive psychoses...
This landmark book is a valuable resource for every mental health clinician. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study was designed to bring together quantitative and clinical methods to describe schematized views of self. A hierarchical cluster analysis was conducted on a single S's ratings of self in 9 contexts. Descriptors had been generated by the S (seen in therapy for social phobia) in dream reports, interviews, and projective test responses. The 4...
This study was designed to bring together quantitative and clinical methods to describe schematized views of self. A hierarchical cluster analysis was conducted on a single S's ratings of self in 9 contexts. Descriptors had been generated by the S (seen in therapy for social phobia) in dream reports, interviews, and projective test responses. The 4...
Discusses the cardinal signs and symptoms of posttraumatic stress disorder (PTSD), with an emphasis on the most important key experience: loss of control over the representation of ideas, images, and/or emotions, or loss of volitional control of behavior. People complain of unbidden images and nightmares, of broken sleep and intolerable pangs of em...
The mourning process may serve an evolutionary purpose, one that has allowed maximum survival characteristics. By passage through the phases of grief, the bereaved person prepares to make new commitments to others and to accept new personal roles. This passage involves an unconscious change in mental structures of meanings about the self and other...
P>Diagnoses follow committee-based criteria. These are the product, ideally, of research on sensitivity and specificity of the candidate symptoms for the criteria but usually the reality is one of clinician consensus for inclusions. Narcissistic personality disorders (NPD) have had little empirical attention in this regard.
ABOUT THE AUTHOR
Mar...
Recurrent maladaptive interpersonal relationship patterns are a central characteristic of the personality disorders and the main focus in dynamic, cognitive, and family psychotherapies. In dynamic formulations the emphasis is on examining conflict in terms of opposing wishes, fears, and defenses. Such formulations can take place at various levels o...