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August 1995

Role-Relationship Models for Case Formulation

Author Affiliations

From the Department of Psychiatry, University of California, San Francisco (Dr Horowitz); Department of Psychiatry, University of Louisville (Ky) (Dr Eells); and Department of Psychology, Yale University, New Haven, Conn (Drs Singer and Salovey).

Arch Gen Psychiatry. 1995;52(8):625-632. doi:10.1001/archpsyc.1995.03950200015003

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 multipleselves 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.

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