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August 1995

Progress on Case Formulation

Author Affiliations

Center for Psychotherapy Research Department of Psychiatry University of Pennsylvania 3600 Market St Philadelphia, PA 19104-2648

Arch Gen Psychiatry. 1995;52(8):639-641. doi:10.1001/archpsyc.1995.03950200029006

READERS of the Archives may be unfamiliar with some of the recent advances in methods for psychodynamic formulation. Horowitz and colleagues1 continue to make important contributions to this developing field, and therefore we hope to highlight the strengths and weaknesses of their article.

BACKGROUND  Some background on the history of research on psychodynamic formulation may help to put the work by Horowitz and colleagues in context. Many earlier attempts2 to assess the agreement of clinicians in arriving at a psychodynamic formulation resulted in poor interjudge reliability. This failure to achieve adequate agreement was likely a function of three major issues: (1) There is not one psychodynamic theory but many theories, often quite distinct and often only loosely articulated, thus leading to different clinicians formulating dynamic issues in discrepant ways based on their discrepant theories. (2) Even among clinicians of the same theoretical persuasion, an approach that allows judges