Complexity of the self: A developmental approach to psychopathology and therapy 0898620120

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ADevelopmental Approach to Psychopathology and Therapy

COMPLEXITY OF THE SELF A Developmental Approach to Psychopathology and Therapy Vittorio F. Guidano, M.D. "Vittorio Guidano has established himself as one of the 'leading edge ' thinkers and practitioners in the growing interface between cognitive and clinical sciences. He has masterfully integrated concepts from such diverse specialties as cognitive psychology, evolutionary epistemology, attachment theory, psychotherapy process, and lifespan development. In COMPLEXITY OF THE SELF"he develops the notion that an individual's 'self system' constitutes the central forum of psychological change. His ideas are congruent with extensive research literatures on identity and self psychology and he shows how they can be usefully incorporated into therapeutic practice. I know of no other volume that so thoroughly addresses this important domain, and I recommend COMPLEXITY OF THE SELF as essential reading." -Michael Mahoney, Ph.D. In this profound work , Vittorio Guidano expands upon his earlier seminal contributions on the application of cognitive and developmental principles to individuals struggling with various forms of psychopathology. Here, he fully develops the idea that individuals' experiences, both positive and negative, are powerfu Ily influenced by their personal "psychological organizations." Focusing primarily on the eating disorders, the phobias (with agoraphobia as the prototype), obsessive-compulsive patterns, and depression , Guidano illustrates how early developmental experiences and ongoing psychological processes may collude to perpetuate dysfunctional patterns and personal distress. The central and perhaps most exciting thesis in this new expression of Guidano's thinking is that the "deep structure" or "core organizing processes" that constrain human psychological experience may be at the heart of successcontinued on back flap

continued from front flap ful intervention as well as the classical problems of resistance, relapse, and refractory behaviors. Guidano's contention is at once simple and powerful: those psychological processes involved in the development and maintenance of personal identity or "self" should be the primary focus of research and intervention in psychological disorders. This timely and provocative volume offers exciting new ideas about how to conceptualize and facilitate change in the "self system." With the rare combination of his Renaissance intellect and integrative practical expertise, Guidano has been able to draw together many disparate themes from object relations theory, ego psychology, attachment theory, constructivist models of human cognition, and lifespan developmental psychology. It is must reading for the practicing professional, the helping apprentice, and anyone interested in glimpsing the cutting edge at the growing interface between cognitive and clinical science.

Cover design by Howard Brotman

COMPLEXITY OF THE SELF

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THE GUILFORD CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY SERIES Michael J. Mahoney, Editor

COMPLEXITY OF THE SELF: A DEVELOPMENTAL APPROACH TO PSYCHOPATHOLOGY AND THERAPY Vittorio F. Guidano EMOTION IN PSYCHOTHERAPY: AFFECT, COGNffiON, AND THE PROCESS OF CHANGE Leslie S. Greenberg and Jeremy D . Safran RELAPSE PREVENTION: MAINTENANCE STRATEGIES IN THE TREATMENT OF ADDICTIVE BEHAVIORS G. Alan Marlatt and Judith R. Gordon, Editors COGNITIVE-BERAVIORAL THERAPY FOR IMPULSIVE CHILDREN Philip C. Kendall and Lauren Braswell PAIN AND BEHAVIORAL MEDICINE: A COGNITIVE-BEHAVIORAL PERSPECTIVE Dennis C. Turk, Donald Meichenbaum, and Myles Genest COGNITIVE PROCESSES AND EMOTIONAL DISORDERS: A STRUCTURAL APPROACH TO PSYCHOTHERAPY V. F. Guidano and G. Liotti AGORAPHOBIA: NATURE AND TREATMENT Andrew M. Mathews, Michael G. Gelder, and Derek W. Johnston COGNITIVE ASSESSMENT Thomas V. Merluzzi, Carol R. Glass, and Myles Genest, Editors COGNITIVE THERAPY OF DEPRESSION Aaron T. Beck, A. John Rush, Brian F. Shaw, and Gary Emery

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COMPLEXITY OF THE SELF A DEVELOPMENTAL APPROACH TO PSYCHOPATHOLOGY AND THERAPY

VITTORIO F. GUIDANO Center for Cognitive Therapy Rome, Italy

THE GUILFORD PRESS New York London

© 1987 The Guilford Press A Division of Guilford Publications, Inc. 200 Park Avenue South, New York, N.Y. 10003

All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Printed in the United States of America Last digit is print number: 9 8 7 6 5 4

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Library of Congress Cataloging-.i n-Publication Data Guida.no, V~ F. Complexity of the self (The Guilford clinical pyschology and psychotherapy series) Bibliography: p. Includes .i ndex. 1. Self. 2. Psychology, Pathological. 3. Developmental psychology. I. Title. IL Series. [DNLM: 1. Cognition Disorders. 2. Ego. 3. Mental Disorders-etiology. 4. Mental Disorders-therapy. 5. Self concept. WM 100 G946c] RC455.4..S42G85 1987 616.89 87-350 ISBN 0-89862-012-0

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To Mike Mahoney and to the timeless time of our conversations in Piazza Navona and Le Papillon.

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ACKNOWLEDGMENTS

I wish to acknowledge my gratitude to the Center for Cognitive Therapy of Rome for their assistance and cooperation, and in particular to my friends Mario Reda and Antonio Caridi, with whom I have long and fruitfully discussed the principal ideas presented in this book. I also thank Priscilla De Angelis and William Lyddon for helping me put the work in the final English form. It is impossible to mention the names of all the colleagues to whom I am indebted for their critical comments and constructive suggestions. All I can say is that had I not had the chance to read their works and discuss with them so many points, this book would never have been written. Nevertheless, I am extremely pleased to address special thanks to at least three of them, for their important contributions to my personal and scientific development. With his scientific work, valuable suggestions, and generous encouragements, John Bowlby has long been an inspiring model of scientific attitudes and clinical wisdom. I am also grateful to Walter B. Weimer for the epistemological and methodological rigor he has evoked in me each time we have met. Finally, I thank Michael J. Mahoney for the brotherly friendship with which he always turns our scientific discussions into something more special and unique.

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PREFACE

This work belongs to a trend of research initiated over 10 years ago and directed toward the development of a scientific model of cognitive psychotherapy. Throughout many years of clinical practice and research, I have come to believe that a comprehensive model of human psychopathology is essential for the elaboration of reliable psychotherapeutic strategies. On the other hand, up to this moment psychology has traditionally addressed clinical disturbances primarily within a descriptive and dispositional framework whose main aim was to reduce the complexity and variability of emotional disorders by compressing them into a range of suitable terms and labels. Even though in the last decade some brilliant and promising cognitive approaches have made their appearance (Beck, 1976; Dobson, in press; Goldfried, 1982; Guidano & Liotti, 1983; Mahoney, 1980, in press; Meichenbaum, 1977; Reda & Mahoney, 1984), the psychotherapeutic field continues to be an ambiguous domain whose scientific ground remains questionable. Accordingly, I am convinced of the growing need for cognitive psychologists to address more of their clinical research to the elaboration of a unitary, developmental, process-oriented model of psychopathology. Such a model would seek to assess the processes and conditions that give rise to specific individual knowledge organizations that when unbalanced, produce the patterns we commonly call clinical disturbances. In order to move in this direction, however, I found it necessary to make some basic choices, from both epistemological and methodological points of view. Relevant to my epistemological premise are the limits inherent to an empiricist-associationist paradigm-a model that still bears so much influence on contemporary psychology. The shortcomings of this paradigm primarily reside in an overly simplistic conception of man and the world. If we assume that the order with which we are acquainted is given and belongs as such to reality, then

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PREFACE

the human mind become_s simply a passive receptor of this outside order and is determined by it more or less entirely (Bever, Fodor, & Garnett, 1968; Hayek, 1952; Liotti &·Reda, 1981; Mahoney, 1984; Weimer, 1977). This perspective, while presenting the indubitable qualities of simplicity and parsimony, also has the undeniable disadvantage of making all the more intractable the understanding of higher mental processes that is essential to the elaboration of any comprehensive model of psychopathology. Over the last decade, primarily within the natural sciences, a totally different perspective has emerged that might instead be termed an "epistemology of