Psychodynamic formulation, consensual response method, and interpersonal problems.

Abstract

We describe a new method for aggregating psychodynamic formulations of independent clinicians. 15 patients (10 female and 5 male, aged 23-41) were interviewed before they began brief dynamic psychotherapy. Different panels of 8 formulators (drawn from a pool of 72 psychodynamic clinicians with 10-38 years of clinical experience) observed each videotaped interview and wrote individual formulations. The text of each formulation was divided into thought-units, and thought-units that occurred 3 or more times were combined into a final consensual formulation. (One case was formulated twice to demonstrate the replicability of the method). Other clinical raters then read each consensual formulation and judged, for a list of interpersonal problems, whether each problem was apt to be distressing for that patient. The raters were very successful in predicting which problems were later discussed in treatment. Predictions were best for formulations with a high proportion of interpersonal content.

The Consensual Response Psychodynamic Formulation: Part 2. Application to Case of Ms. smithfield

“…First, it contains a relatively lower proportion of interpersonal thought-units than we have observed in our normative study (Horowitz et al, 1989). That is, the number of thought-units describing other people and interpersonal content is proportionately lower than was usual in our sample of patients judged to be suitable for brief dynamic psychotherapy.…”

“…The patient did mention other people during the interview, but her descriptions had a one-dimensional quality in which she was typically exploited or victimized by them; an in-depth sense of how she relates to other people was lacking. We have found previously that a low proportion of interpersonal content is associated with a relatively poor outcome in brief dynamic psychotherapy (Horowitz et al, 1989). Apparently, patients who do not describe other people clearly are not good candidates for brief dynamic psychotherapy since the work of a brief dynamic psychotherapy seems to require a capacity to engage in and to reflect about interpersonal relationships (Horowitz, Rosenberg, & Kalehzan, 1992).…”

The clinical focus as process variable in brief psychotherapy: A review of current status and reconsideration

“…Once therapists dearly understand a significant theme, he or she could choose from a variety of interventions. Currently however, there are no procedures for generating a narrative type of dynamic formulation that is standardized, reliable and valid (Horowitz, 1989).…”

“…The psychodynamic formulation is described as a narrative that succinctly describes the nature and etiology of a patient's psychological problems (e.g., theme of autonomy) (Horowitz et al, 1989). As noted by Horowitz et al (1989) " .…”

The Role-Relationship Models Method: A Comparison of Independently Derived Case Formulations

“…Maladaptive Pattern (Henry, Schacht, & Strupp, 1986;Johnson, Popp, Schacht, Mellon, & Strupp, 1989), the Idiographic Conflict Formulation method (Perry & Cooper, 1985, 1986, the Consensual Response Formulation method (L. Horowitz, Rosenberg, Ureno, Kalehzan, & O'Halloran, 1989), and the Role Relationship Model Configuration method (RRMC; M. Horowitz, 1989;1991). Empirical efforts to achieve higher rates of interclinician agreement using these and similar methods have met with generally encouraging results (Curtis et al, 1988;M.…”