AT A TIME when health maintenance organizations of all kinds are paying little or nothing for psychotherapy of Axis I, much less Axis II, disorders, many, if not most, psychiatry departments seem to be cooperating by emphasizing DSM-IV1 diagnoses and drug treatment. In my own department, 11 of 25 psychiatric grand rounds in the past academic year were sponsored by drug companies. Guess what diagnoses they are interested in?
Therefore, it is refreshing to read the focus by Horowitz et al2 on avowed personality problems. For the last 10 years, with MacArthur Foundation support, Horowitz and colleagues have pursued "configurational analysis," by which they mean a case formulation method that is also, to some extent, an explanatory model of the patient's pathological, maladaptive interactions with other people. The role-relationship model (RRM) configurations, as they call them, are designed "to inform us about how and why an individual repeats