Cognitive Psychodynamics: From Conflict to Character

Dr. Horowitz is one of the long-distance runners in psychiatric clinical research and practice. Since his early publications in the late 1960s on psychic trauma, he has continued to focus his work on the impact of trauma on development, on temperament and socially structured character, and on what he refers to as the individual’s working models and enduring schema. In this book, as in some of his earlier summary statements, he attempts to broaden the application of his findings to understanding the impediments to “living well”— the ability to experience “passion, resilience to challenges, and a reasoned, morally tenable maintenance of commitments” (p. ix)—and to the ways in which we can help people out of the mess and morass of daily living caused by the continuing pressures of their past.

Most investigators struggle to limit the number of variables they study. They search for “clean” samples, such as first episodes of depression in individuals without alcoholism or character disorder. The danger is that the results often do not apply to the real world, where almost all cases are complex and confusing. At its most successful, such research supplies us with bits of helpful information and with a simplified (but not simplistic) view that helps us organize an understanding of our patients. Cognitive psychodynamics falls into this second group of useful simplifications. Horowitz attempts to integrate cognitive science into psychoanalytically based dynamic thinking and to avoid the old and somewhat forbidding jargon, including such terms as “id” and “cathexis.” Although Horowitz avoids the old jargon and his new terms are closely related to those of allied fields, they do not add materially to understanding. They merely relabel, like the change from “insane asylum” to “mental health center.” I am not convinced that the content is changed.

Horowitz’ clinical examples all seem very clear and understandable, in contrast to my own practice, and all seem to end happily. However, they are a clear explication of the text. Cognitive Psychodynamics is an excellent introduction to issues of conflict and character and to the problems of helping people change the ways in which they live out their fantasies and their lives. It will help medical students and other trainees begin to understand the multiple meanings of people’s behavior. For more experienced clinicians, it can serve as a useful summary of the current state of our art.