PsycCRITIQUES - Toward a Unified Model: Personality Systems and Relational Psychotherapy

Toward a Unified Model: Personality Systems and Relational

Psychotherapy

A review of

Personality-Guided Relational Psychotherapy:

A Unified Approach
by Jeffrey J. Magnavita
Washington, DC: American Psychological
Association, 2005. 359 pp. ISBN 1-59147-213-X.
$59.95

Reviewed by
Brian H. Stagner

Years ago, during internship interviews, a training director asked

how I reconciled reading Winnicott with my practicum in strategic
family therapy. I could not and lamely replied that these were different
interests, pursued on different days. For most therapists, each of the
many approaches to psychotherapy seems incomplete, yet none
inconsequential. Theorists advocate for a particular perspective,
seeking to differentiate their positions from competing positions. Like
the blind men with the elephant, they have

Disputed loud and long,

Each in his own opinion

Exceeding stiff and strong,

Though each was partly in the right,

And all were in the wrong!

—John Godfrey Saxe, The Blind Men and the Elephant

Knowledge explosions in behavioral genetics, brain-behavior

research, and health psychology have compounded this problem: We
need to integrate across domains of exploration. In this spirit, Theodore
Millon is editing a series of volumes on personality-guided psychology
published by the American Psychological Association. Personality-
Guided Relational Psychotherapy: A Unified Approach is one of the first
in this series and extends both the editor’s earlier work on personality-
guided therapy (Millon, Grossman, Millon, & Everly, 1999) and the
author’s extensive writing about psychopathology and psychotherapy.
Jeffrey J. Magnavita is a successful clinician and a scholar with a
personality textbook and several books on the treatment of personality
disorders to his credit. He champions Millon’s belief that treatment
should be guided first by the personality of the client; specific
syndromes are the expression of the breakdown of the personality
system, broadly defined. This book calls for returning to the individual
personality in case formulation and for placing relational systems in the

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PsycCRITIQUES - Toward a Unified Model: Personality Systems and Relational Psychotherapy

spotlight of treatment.

Theoretical Underpinnings

The first section provides overview chapters on personality,

psychopathology, and treatment, each of which could be a book unto
itself. These overviews emphasize relevant theory rather than critical
analysis and integration of research findings. Even as restricted, the
scope may leave readers dazed. Magnavita reviews most of the major
theoretical developments of the past 50 years, touching on every level
of inquiry from the neurologic to the intrapsychic, the dyadic, the
familial, and on to the cultural. It is as if the many blind men are
frantically sending in field reports and the author is back at
headquarters trying to paste them into a unified picture.

What, exactly, is to be unified? A sample of concepts referenced in

the overview of theory includes the role of the hippocampus in
mediating trauma, attachment theory, psychoanalytic ideas about
defenses, Benjamin on dyadic processes, Mahler’s work on the
unfolding of intrapsychic processes, Ram Dass’s idea of dysfunctional
cosmology, von Bertalanffy’s notions about boundaries, Gould on
punctuated equilibrium, Haley’s conceptualization of the adaptive
function of triangles, the influence of Kurt Lewin on Bronfenbrenner,
and Berscheid’s declaration of the emergence of relational science, and
we haven’t begun to discuss therapy yet. Magnavita hasn’t quite
written a theory of everything, but he taps seminal ideas across many,
many domains.

Several conceptual tools are offered to help manage these disparate

domains. The author invokes systems theory of von Bertalanffy and
others to conceptualize understanding multiple levels of analysis. The
concept of a holon is borrowed from Ken Wilber (who did propose a
theory of everything—Wilber, 2000). A holon is defined as a whole that
is part of other wholes; reality is made up of part/wholes. Holonic
thinking leads us to ask how different parts make up a given whole and
how this whole is part of other wholes in the system. Magnavita calls
for the creation of a holonic map of an individual that will consider
multiple levels of understanding.

To organize this, Magnavita draws on ideas he has developed in

previous books, providing a useful schematic involving four inverted
triangles organized side by side to represent a progression from
microsystems to macrosystems to mesosystemic levels. The first
triangle is the intrapsychic/biological level. This is the locus of
emotional differentiation, involving basic neurobiological processes, the
cognitive/affective matrix, the experience and expression of anxiety,
and the development of defenses. The second triangle is the
interpersonal/dyadic system, in which interpersonal processes are
grounded in early dyadic relations and through which we experience
and express relationship expectations and current relationships. Third is
the relational/triadic configuration, which refers to the process by which
shaky dyads attempt stabilization by triangulating in a third party; such
triads are often pathogenic, producing symptoms in the triangulated
third person. Finally, the sociocultural/familial triangle represents the
reciprocal interaction of social and cultural forces, family processes, and
the individual personality subsystem.

Tactics for Assessment

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PsycCRITIQUES - Toward a Unified Model: Personality Systems and Relational Psychotherapy

The client is thus a hierarchy of subsystems that are reciprocally

interacting. Pathology occurs as a result of trauma. Magnavita believes
we need a holonic map to appreciate the pathogenic impact of trauma
because, no matter how precise and accurate, a DSM diagnosis will not
be adequate for treating complex problems. To devise treatment
strategies, we need to understand the impact of trauma on each of the
four subsystems described above.

Magnavita advocates a relational diagnostic system. This assumes

that personality is formed through our earliest interpersonal
experiences and is shaped by the interpersonal relationships in each
family system. Furthermore, it is assumed that disorders of personality
involve disturbances in the relational matrix, including (especially)
defenses against intimacy that thwart the healing power of relatedness.
These disturbances are often maintained and exacerbated by cultural
and family systems. Magnavita reminds us that none of these systems
is ever static, that assessment is never complete but always ongoing,
that multiple data points improve our understanding, and that systems
must be understood in light of the environments in which they function.
There is no startlingly new idea in these aspirational reminders, but the
author is up to more than cheerleading: The goal, stated in the preface,
is to provide the scaffold for a unified system.

The author presents a very substantive discussion of how to

evaluate personality systems in light of the component triangle,
describing each subsystem in detail. He discusses the variables that are
relevant for each domain and invokes (in a general way) the research
base that supports clinical inference. This material is more clinical and
less abstract than the theoretical material that precedes it, and it will
be much appreciated by the student or practitioner who seeks a richer
set of conceptual tools.

Very useful and specific assessment strategies are provided for

each domain or matrix. For example, in the relational/triadic matrix,
Magnavita presents a taxonomy of dysfunctional personologic systems
that he has developed in previous work. Ten pathological family
systems are discussed. For each one, he describes the organizing
theme (e.g., addiction, empathic failure, us vs. them, etc.), the
communication patterns, and the relational issues (e.g., codependence,
affirmation through caretaking, cohesion through paranoia) that
characterize the system and contribute to the emergence or
reinforcement of pathology.

Treatment Strategies

The discussion of treatment strategies begins about halfway

through the book, but for most practitioners, this will be the vital core,
and it does not disappoint. Magnavita has assembled multiple
strategies for intervening at each level, and he attempts to understand
how specific interventions may have an impact on other levels. The
earlier sections of this book leave no doubt that the author is a
prodigious reader, but here we really feel the immediate benefit of the
author’s deep clinical sophistication. Seasoned practitioners will
recognize that Magnavita has done the heavy lifting to extract practical
gems from wherever they can be mined in the clinical literature. Where
alternative strategies have been developed, these are presented.

This book exceeds most efforts at unifying disparate branches of

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PsycCRITIQUES - Toward a Unified Model: Personality Systems and Relational Psychotherapy

therapy because of the detail with which the many techniques are
explicated. For example, several strategies are presented for defensive
restructuring (interventions involving the intrapsychic triangle). Each
strategy may be expected to mobilize different levels of anxiety. Thus,
supporting defenses or invitations to intimacy produce relatively low
anxiety, demonstration or intensification of defenses mobilizes
moderate anxiety, and confrontation of defenses elicits high anxiety.
The theoretical background of each of these strategies is illuminated,
and in many cases, brief case material supplements the discussion.
This analysis is thoughtful, succinct, and immediately applicable. The
material on restructuring the intrapsychic system will probably be
familiar to most therapists as it builds on well-established principles
from psychodynamic, cognitive, and pharmaceutical interventions.

The chapters that follow focus on restructuring the interpersonal/

dyadic triangle and reconfiguring the relational system and draw, to
some extent, on ideas with which many readers will be less familiar.
Dyadic restructuring takes the two-person relationship as the unit of
analysis. It is based on the work of Murray Bowen (but informed by
many other thinkers, most notably Lorna Smith Benjamin and several
object-relations theorists). Dyadic restructuring pursues the twin goals
of increasing both emotional differentiation and self-differentiation.
Work at this level requires understanding of a client’s early relational
matrix, current relational matrix, and expected relational system.
Several strategies may be used. Treatment may emphasize the
restructuring of the expected transactions or the restructuring of self/
other expectations. Other strategies may be employed in couples or
group treatment.

Triadic restructuring involves interventions at the level of family

relationships. This may not necessarily mean family therapy but may
simply reflect the fact than an individual may develop problems in
response to changes in family processes (due to life events such as
births or departures of children). As with the previous two sections,
Magnavita presents several restructuring strategies and their subtypes.
The goals of treatment at this level include increasing flexibility (to
permit the system to meet new challenges), increased tolerance for
anxiety, better problem solving, and others. Detriangulation (of a child,
an in-law, or an extramarital liaison) and strengthening appropriate
subsystem functions are the tasks employed to meet these goals.

Confronting the mesosystem is more aspirational and more abstract

than the previous sections, which is another way of saying that this
section is more illustrative than instructive. Readers are reminded that
symptoms are contextual. Social, cultural, economic, religious, and
varyingly technologically developed domains contribute to the
mesosystem, and mesosystems themselves have patterns of structure,
organization, process, and function that shape and constrain
possibilities for an individual personality system. Psychologists are
urged to become more aware of the mesosystems in which they
operate and, when the mesosystem is itself pathological, to address the
dysfunction at that level (e.g., work to improve the pathological aspects
of correctional facilities).

The book concludes with a chapter on integrating this unified

relational approach into different service-delivery packages and a
chapter on the need to shift the implicit research paradigm toward
examination of multilevel networks encompassing personality systems.
Magnavita hopes to promote the simultaneous, integrated exploration

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PsycCRITIQUES - Toward a Unified Model: Personality Systems and Relational Psychotherapy

of multiple domains of personality systems. It is not clear that currently

available research techniques are adequate to this task. One hopes that
he and his colleagues will follow up with innovative and
methodologically rigorous exemplars.

Practitioners will like this book. The clinical nuts and bolts lend
conceptual guidance in selecting strategies and choosing tactics in the
treatment room. For the clarity and usefulness of these sections, this
book will be useful to both new and seasoned therapists. At the
theoretical level, this book is far more ambitious than the title
suggests. Although it does have a very strong foundation in relational
psychotherapy, it attempts integration far beyond the relational level of
analysis. The most theoretical sections are more evocative than
prescriptive. Readers will judge for themselves whether Magnavita has
successfully constructed the scaffold of a unified approach or has
simply identified the parts. Some (including this reader) may feel that
the breathless flyover of all those concepts covers too much to master
in the space available and wonder whether the unification is more
apparent than substantive, but this is churlish. What is important is
that the author is making a serious effort to think like this. This book is
about bringing psychotherapy back to richness of theory and
reconnecting practitioners with the theoretical heritage of personology
while integrating new discoveries from more reductionistic approaches.
In many places, this aspiration is fleshed out with well-specified
conceptualizations and specific clinical strategies, thereby providing
encouragement that the grand project of unification may ultimately be
possible.

References

Millon, T., Grossman, S., Millon, C., & Everly,

G. (1999). Personality-guided psychotherapy. New York: Wiley.
Wilber, K. (2000). A theory of everything: An integral vision for
business, politics, science, and spirituality. Boston: Shambhala.

© 2005 by the American

PsycCRITIQUES
Psychological Association
May 18, 2005 Vol. 50, No. For personal use only--not for
20, Article 3 distribution.

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