Am J Psychiatry 1994; 151:1767-1770
Copyright © 1994 by American Psychiatric Association
Cyclical patterns of states of mind in psychotherapy
MJ Horowitz, C Milbrath, M Ewert, D Sonneborn and C Stinson
Program on Conscious and Unconscious Mental Processes, John D. and Catherine T. MacArthur Foundation, University of California, San Francisco.
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.
