Mardi J. Horowitz - Adult Personality Growth in Psychotherapy

University Printing House

Psychotherapy for personality growth aims towards augmenting a sense of identity,enriching relationships, and enhancing control of emotion. Integration ofthese key factors requires that a person learn to modify a narrative of characteristicsof self in the present as articulated to the past and having future goals.Therapy towards these ends changes mental structures through both consciousand unconscious processing. New modes of thinking about self and others means navigating emotionalwaters that have seemed turbulent. Safety in that course occurs by developing atherapeutic alliance, having frank conversations about dangers, and exploringnew ways of coping with them rather than avoiding them. While important,insight is not the sole road to such adaptive changes. New relationship experiencescan also lead to signicant and enduring changes in attitudes, intentions,and expectations.This book uses contemporary theories from cognitive and psychodynamicsciences, especially a modern understanding of the operation of schemas andemotional-control processes. Clinicians operating within cognitive-behavioraltherapy frameworks, especially, may value this component of complexity in caseformulation. Clinicians trained in psychodynamic therapy may value the specicemphasis on techniques to promote present moments of learning.My approach includes attention to how a clinician can understand and modifysymptoms, problems, and pathogenic feelings and thoughts. It also addresses howa therapist can increase a patients capacity for resilience, strength, and creativity.I do not argue that what I present is altogether new. Instead, I combine knownelements from many sources while trying my best for brevity, clarity, and illustration.I believe the results are consistent with modern neuroscience, developmentalpsychology, and socio-cultural understanding.Change involves the modication of congurations of meanings about identityas nested in attachments. That is why this book will progressively examine andillustrate layers of self-beliefs and narratives. This is the reason I begin with asection of three chapters focused on identity and its variation across dierentstates of mind. The second section, consisting of three chapters, centers on relationship patternsand capacities. The nal section of three chapters examines emotionalcontrol.

My academic home has been the University of California San Francisco and I thank all the patients, trainees, and faculty colleagues who have made my work over decades rewarding and stimulating. Colleagues in the MacArthur Program on Conscious and Unconscious Mental Processes, which I directed, and the sta in Chicago were also immensely supportive. The National Institute of Mental Health supported much of the research on which the knowledge in this book is based, and psychotherapy research colleagues around the world have also made it all possible. My wife, Renee Binder, M.D., is also President of the American Psychiatric Association, and Past Chairman of UCSF Psychiatry. In addition to support throughout, we have studied the key issues of where does psychotherapy go next, in relation to diagnoses and formulations. Zack Vanderbilt did major work in getting all aspects of the manuscript together. He contributed important feedback on the ideas and how they were presented. I am proud of his work. Marilyn Spoja and Bente Mirow helped rene the writing. Then Drs. Kat Lopez, Nadia Taylor, Paul Elizondo, Wendy Feng, Adam Goldyne, Chelsea Young, Tracy Foose, Serina Dean, and Alice Huang were the most vital readers who led to clarity and augmentation.