Working with the Core Relationship Problem in Psychotherapy

A clinician's Rosetta Stone for understanding and treating presenting problems

"I highly recommend this book to therapists of all persuasions."--Allan N. Schore, department of psychiatry and biobehavioral sciences, University of California at Los Angeles School of Medicine

In this important book, noted author, teacher, and psychologist Althea J. Horner shows how to reveal, understand, and use the powerful core relationship problem -- which is formed from earliest childhood and creates an image of the self in relation to others -- so it can act as a Rosetta stone for understanding the underlying conflict that repeatedly plays out in a client's behavior. Once this essential element is uncovered, clinicians learn how to work with their clients to successfully resolve common presenting problems.

Foreword ix
Samuel Slipp

Preface xi

Introduction: The Unconscious and the Archaeology of Human Relationships xvii

Part One: The Core Relationship Problem 1

1 Construction of the Developmental Hypothesis: The Hypothesis

2 Construction of the Developmental Hypothesis: Method of Data Gathering 11

3 The Place of the Signifier in Psychoanalytic Object Relations Theory 23

4 The Contribution of Family System Pathology to Core Relationship Problems 35

5 Belief Systems and the Analytic Work 45

Part Two: some Common Clinical Problems and Issues 51

6 Deciphering the Compromise Formation: A Psychological Rosetta Stone 53

7 OCD: The Medicalization of Psychopathology and the Importance of Preserving a Psychology of the Mind 59

8 Working with Dissociated Self-States 69

9 Cherchez la Mere: Disturbances of Object-Seeking Behavior in the Wake of Early Abandonment Experiences 77

10 Money Issues and Analytic Neutrality 83

11 Religion, Values, and Clinical Issues 93

12 The Therapist’s Core Relationship Problem: Countertransference Resistance 99

13 Moments of Decision: What Do I Say? What Do I do? 107

Part Three: Difficult Patients and Clinical Problems 115

14 Interminable Therapy and Transference Resistance 117

15 When Helping doesn’t Help: The Negative Therapeutic Reaction 123

16 The Masochistic Personality Disorder – A Diagnosis worth Keeping: Working with the Good Girl and the Good Boy 129

17 “Those Wrecked by Success” Revisited: Envy and the Fear of Being Envied 143

18 Managed Care as a Clinical Issue 149

Part Four: For Supervisors Only 155

19 Core Relationship Problems and the Supervision Process 157

References 165

About the Author 173

About the Foreword Author 175

Index 177

"In this important book, Dr. Althea Horner, a remarkably skilled theoretician, continues to expand her developmental object relational model, a perspective that is solidly grounded in very recent findings in developmental psychopathology and neurobiology. But in addition, as a master clinician, she then demonstrates how an understanding of early- forming core relationship problems can offer penetrating insights into working with characterological disturbances. Due to her integrative contributions and extraordinary ability to explain complex clinical phenomena in clear and accessible language, I highly recommAnd this book to therapists of all persuasions." --Allan N. Schore, department of psychiatry and biobehavioral sciences, University of California at Los Angeles School of Medicine

"Once again, Althea Horner demonstrates that she is a master of the theory and practice of psychodynamic psychotherapy. In her latest book, Horner goes directly to the heart of the treatment. She clarifies the importance of identifying the core relationship problem early in treatment as it is the organizing principle for understanding the many layers of adaptive/defensive elaboration that accrue over the years. . . .The Core Relationship Problem in Psychotherapy is full of material that all clinicians--beginner and seasoned practitioners alike--will find thought provoking and rewarding." --Marion Solomon, author of Narcissism and Intimacy

"A testament to concision, wisdom, and instruction in psychotherapy. . . . My own experiences with patients flickered constantly through my thoughts as I read, and I was pleased to find new insights into clinical encounters about which I had previously been complacent. The handling of specific. . . . clinical issues all are considered with nondogmatic sensitivity." --Douglas H. Ingram, dean, American Institute for Psychoanalysis and clinical professor of psychiatry, New York Medical College

"Dr. Horner does it again! Her clear, concise style and compassionate tone draws the reader effectively through an education in the theory, art, and practice of psychodynamic psychotherapy, utilizing the core conflictual model. Every aspect of this most difficult of professions is elucidated by a elegant and common sense approach that leaves the student of psychotherapy with the feeling of having been touched by a master clinician." --William H. Rickles, M.D., private practice, Los Angeles, CA ALTHEA J. HORNER is a distinguished author, teacher, psychologist, and author of many classic and award-winning books including Object Relations and the Developing Ego in Therapy, Being and Loving, The Wish for Power and the Fear of Having It, Treating the Neurotic Patient in Brief Psychotherapy, and Psychoanalytic Object Relations Therapy. In this important book, noted author, teacher, and psychologist Althea J. Horner shows how to reveal, understand, and use the powerful Core Relationship Problem?which is formed from earliest childhood and creates an image of the self in relation to others?so it can act as a Rosetta stone for understanding the underlying conflict that repeatedly plays out in a client's behavior. Once this essential element is uncovered clinicians can work with their clients to successfully resolve common presenting problems.Grounded in the author's wealth of research and practical experience, the book is filled with illustrative examples and accessible information that demonstrates how to work with difficult personality types and problematic issues that often surface during the course of therapy. For example, the author explains how to achieve results with clients who exhibit obsessive- compulsive disorder, dissociated states, and Don Juan behavior. She also shows how to react if a client wants to be hugged, offers a gift, or resents paying for treatment. In addition the book offers practical advice on how to handle the difficult issues of transference/countertranference and work with clients who can sabotage the therapeutic process by trying to win over the therapist.As timely as it is comprehensive, the book offers specific recommAndations for dealing with termination issues and offers solutions for the special problems that can arise when working with patients in a managed care environment. The book is also a vital resource for therapists who are in a supervisory position. In this important book, noted author, teacher, and psychologist Althea J. Horner shows how to reveal, understand, and use the powerful Core Relationship Problem?which is formed from earliest childhood and creates an image of the self in relation to others?so it can act as a Rosetta stone for understanding the underlying conflict that repeatedly plays out in a client?s behavior. Once this essential element is uncovered clinicians can work with their clients to successfully resolve common presenting problems.

Grounded in the author?s wealth of research and practical experience, the book is filled with illustrative examples and accessible information that demonstrates how to work with difficult personality types and problematic issues that often surface during the course of therapy. For example, the author explains how to achieve results with clients who exhibit obsessive- compulsive disorder, dissociated states, and Don Juan behavior. She also shows how to react if a client wants to be hugged, offers a gift, or resents paying for treatment. In addition the book offers practical advice on how to handle the difficult issues of transference/countertranference and work with clients who can sabotage the therapeutic process by trying to win over the therapist.

As timely as it is comprehensive, the book offers specific recommendations for dealing with termination issues and offers solutions for the special problems that can arise when working with patients in a managed care environment. The book is also a vital resource for therapists who are in a supervisory position.