Search PubMed⌕ Search

Biomedical subjects

M J Horowitz

Publications and source records attributed to M J Horowitz.

At least 19 recordsLinked to original sources
PubMed1999

The relation of continuing attachment to adjustment in conjugal bereavement.

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 completed general and grief-specific symptom inventories at 6 months and again at 14 and 25 months postloss. The results indicated that use of the deceased's possessions to gain comfort was positively correlated with concurrent distress in the role-play and predictive to less of a decrease in grief-specific symptoms over time in a growth curve analysis. In contrast, attachment through fond memories was related to less distress in the role-play. The results, therefore, suggest that whether continuing attachment is adaptive or not depends on its form.

Adult↗
PubMed1999

Sequential consequences of therapists' interventions.

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. Results indicated that therapists fit their styles of intervention to patients' levels of distress and functioning. Within the session, patient's emotional elaboration was followed by therapist's defense interpretation, followed by more patient emotional elaboration. Patient elaboration of significance was followed by more transference interpretation, followed by more patient elaboration of significance. Noninterpretive interventions were followed by patient's disclosure of facts, not emotion. Both interpretive intervention process sequences and therapist's use of support predicted posttreatment symptom reduction. The PIRS was shown to have satisfactory reliability and construct validity.

Depressive Disorder↗
PubMed1998

Prediction of complicated grief by positive and negative themes in narratives.

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 bereavement. The coding system was modeled after Erikson's (1982) scheme of crises solutions across the life span. Second, we examined the relationship of these themes to various symptom measures obtained at 6- and 14 months postloss. Results revealed no systematic relationship between corresponding positive and negative themes. Aggregated positive and negative themes showed significant correlations with 6-month measures of intrusion and avoidance and, as predicted, with various 14-month symptom levels. Regression analyses revealed that positive themes explained significant portions of 14-month symptom variance, even when 6-month symptom scores were controlled. Findings are discussed with regard to conceptualizations of grief as a stress response syndrome, where intrusive processes (e.g., in narration) are of importance.

Adaptation, Psychological↗
PubMed1998

Interpersonal ambivalence, perceived relationship adjustment, and conjugal loss.

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. Bereaved participants, relative to a nonbereaved comparison sample, recollected their relationships as better adjusted but were more ambivalent. Ambivalence about spouses was generally associated with increased distress and poorer perceived health but did not predict long-term grief outcome once initial outcome was controlled. In contrast, initial grief and distress predicted increased ambivalence and decreased Dyadic Adjustment Scale scores at 14 months postloss, regardless of initial scores on these measures. Limitations and implications of the findings are discussed.

Adult↗
PubMed1998

Applying an empty-chair monologue paradigm to examine unresolved grief.

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 that they had one last opportunity to do so. They completed a questionnaire at the end of their monologue speech assessing their affective experience during the monologue. It contained items associated with unresolved grief (e.g., anger, guilt, helplessness, nonacceptance). Near the time of the monologue session, bereaved participants also completed the Beck Depression Inventory (BDI) (Beck and Steer 1987) and the Impact of Event Scale (IES) (Horowitz, Wilner, and Alvarez 1979). At 14 months postloss, bereaved participants again were administered the BDI and IES. As hypothesized, the extent of unresolved grief as assessed by the monologue questionnaire at 6 months postloss was predictive of 14-month postloss symptoms, even when statistically controlling for 6-month postloss symptoms in hierarchical regression analyses.

Adaptation, Psychological↗
PubMed1997

Configurational analysis for case formulation.

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 session of a small, three-person family.

Child↗
PubMed1997

Diagnostic criteria for complicated grief disorder.

OBJECTIVE: 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. METHOD: They developed observer-based definitions of 30 symptoms noted clinically in previous longitudinal interviews of bereaved persons and then designed a plan to investigate whether any combination of these would serve as criteria for a possible new diagnosis of complicated grief disorder. Using a structured diagnostic interview, they assessed 70 subjects whose spouses had died. Latent class model analyses and signal detection procedures were used to calibrate the data against global clinical ratings and self-report measures of grief-specific distress. RESULTS: Complicated grief disorder was found to be characterized by a smaller set of the assessed symptoms. Subjects elected by an algorithm for these symptoms patterns did not significantly overlap with subjects who received a diagnosis of major depressive disorder. CONCLUSIONS: A new diagnosis of complicated grief disorder may be indicated. Its criteria would include the current experience (more than a year after a loss) of intense intrusive thoughts, pangs of severe emotion, distressing yearnings, feeling excessively alone and empty, excessively avoiding tasks reminiscent of the deceased, unusual sleep disturbances, and maladaptive levels of loss of interest in personal activities.

Adjustment Disorders↗
PubMed1997

Psychotherapy for histrionic personality disorder.

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-oriented prototype of a treatment plan is linked to these levels of formulation. The result can provide a guideline for clinicians and a teaching document for trainees.

Guidelines as Topic↗
PubMed1995

Role-relationship models for case formulation.

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 multiple-selves approach helps clinicians define core contradictions in belief that are frequently present. METHOD: A configurational system for case formulation was used with an approach of states and person schemas. Transactions and stories involving self and others were observed for recurrent elements of identity, attribution, and action. These elements were systematically arranged as role relationship models for each important state of behavior. Cyclic repetitions of maladaptive interpersonal behavior patterns were then explained in terms of motivations and social events that activate enduring, but erroneous, beliefs. RESULTS: Reliable and valid individualized formulations were derived by means of configurations of role relationship models. Inferring several levels of diverse self and other beliefs clarified the complexity usually found in disorders of personality. CONCLUSIONS: The role relationship models method of formulation is compatible with integrative approaches to treatment planning.

Aspirations, Psychological↗
PubMed1995

Signs of defensive control locate conflicted topics in discourse.

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 was undertaken. METHODS: Brief dynamic psychotherapies of two patients with pathological grief reactions were recorded and reviewed by independent judges. Periods of heightened defensive control of verbal and nonverbal communication were quantified using operational definitions. Reliably scored defensive episodes were algorithmically selected by computer programs. The people and topics discussed by patients were independently scored. RESULTS: Highly defensive periods contained disproportionately more frequent instances of patient discourse about people involved in conflict and unresolved topics. CONCLUSIONS: The findings support the psychodynamic hypothesis that observation of defensive behaviors may locate times of communication about conflicted themes.

Adult↗
PubMed1995

Dysfluency and topic orientation in bereaved individuals: bridging individual and group studies.

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-distress bereaved individuals and with that of single bereaved individual both early and late in psychotherapy. Meaningful differences were observed for the distress groups and for the single individual early and late in therapy, and these findings indicate possible quantitative and qualitative means for detecting maladaptive responses to stressors.

Adaptation, Psychological↗
PubMed1995

When avoiding unpleasant emotions might not be such a bad thing: verbal-autonomic response dissociation and midlife conjugal bereavement.

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 negative emotion coupled with heightened cardiovascular activity) and compared with grief measured at 6 and 14 months. The negative dissociation score evidenced reliability and validity but did not evidence the assumed link to severe grief. Rather, consistent with the adaptive hypothesis, negative dissociation at 6 months was associated with minimal grief symptoms across 14 months. Negative dissociation scores were also linked to initially high levels of somatic symptoms, which dropped to a low level by 14 months. Possible explanations for the initial cost and long-term adaptive quality of emotional avoidance during bereavement, as well as implications and limitations of the findings, are discussed.

Adult↗
PubMed1994

Expressive and defensive behavior during discourse on unresolved topics: a single case study of pathological grief.

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. Conceptually the study is based on a model of defensive control processes that integrates states of mind and person schemas. Theoretically derived measures of discourse topics, verbal and nonverbal defensive behaviors, emotional disclosure, and states of mind were applied to transcripts and videotapes of the entire therapy. Evidence from combined cluster and factor analyses supported the existence of recurring emotionally significant states. Two of these are particularly interesting from a clinical perspective: One, a "shimmering" state of intense emotional expression with concurrent signs of avoidance, was associated with topics identified clinically as stressful, unresolved, and conflictual. The other, a state of more uniformly stifled emotionality, was characteristic of discourse thought of clinically as resistance.

Adult↗
PubMed1994

Cyclical patterns of states of mind in psychotherapy.

OBJECTIVE: 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. METHOD: The authors used reliable systems for scoring a patient's state of mind on videotapes of all sessions of her brief psychotherapy and, using separate procedures, scored the topics of discourse. These data were then examined by means of a lagged log-linear sequential analysis for patterns of shifts from one state to another and for concurrent shifts in topics. RESULTS: The findings indicated nonrandom shifts in state. Patterns of shifting from a well-modulated state to alternative states and back again were overrepresented. Such shifts were related to conflictual topics of discourse. CONCLUSIONS: Observing such shifts in mental state may help psychotherapists to formulate the contents of conflict and also to make technical interventions to stabilize optimal states for doing the work of psychotherapy.

Cognition↗
PubMed1993

Topics and signs: defensive control of emotional expression.

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 emotionally and defensive control during discourse on the topic of the stressor event. In future studies, such measures of verbal and nonverbal signs of emotional expression and defensive control might be used to identify topics in an unresolved state.

Adjustment Disorders↗
PubMed1993

Psyclops: an exploratory graphical system for clinical research and education.

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 already exceeds our usual methods of handling it. Psyclops consists of a suite of software modules, manual sections, and standards that have been developed according to guiding concepts intended to help one collect, organize, access, and explore complex data about a single subject for research, education, and ultimately, clinical care purposes. This document provides background in clinical information science and a description of the system; the reader interested in its application in clinical research theory development is referred to the companion paper in this issue (Horowitz et al., Pathological Grief: An Intensive Case Study).

Arousal↗