Changing Character: Short-term Anxiety Regulating Psychotherapy for Restructuring Defenses, Affects, by Leigh McCullough. New York: Basic Books, 1997.

Reviewed by Jon Frederickson

Theoretically, this is an integrative approach. McCullough replaces Freud’s drive theory with Tomkins’ theory affect. Affects, the primary movers of human motivation, amplify the drives. However, due to attachment failures, patients develop affect phobias. Therefore, the therapist must expose the patient to the avoided affects within an anxiety regulating therapeutic alliance. To do so the therapist must engage in defense restructuring: identify defensive behaviors and inhibitory affects, then show the relationship between the warded off affect, the inhibitory affects, and defensive behaviors, then help the patient relinquish the defense to experience the avoided affect. Affect restructuring involves helping the patient separate adaptive affects and inhibitory affects through repeated exposure to the adaptive affects so that the inhibitory affects lose their power. Self-other restructuring involves working with the patient’s representation of herself and of others and the aversive affects which are triggered.

The book is designed as a teaching text, hence for the beginning student it is quite useful since specific chapters are devoted to the triangle of conflict, how to formulate the core conflicts in a given case, how to help patients identify defenses, how to help patients turn against defenses, how to help patients face and experience previously warded off affects, how to help patients integrate the experiential insights which result from deep affective experience, and how to help patients restructure their inner representations of self and others. McCullough clearly links her theoretical premises to each kind of intervention. Each intervention is illustrated with numerous examples which are analyzed to show how the triangle of conflict is the organizing principle for generating interventions.

McCullough focuses on preconscious affect knowing that unconscious affect will rise with the continual weakening of the defenses. Also, her emphasis on adaptive and defensive behaviors allows her to address implicit procedural knowledge, thereby accessing the unconscious through another avenue than breakthroughs to unconscious murderous fantasies. Theoretically, she integrates: 1) the psychoanalytic concept of conflict with Tomkin’s revamping of drive theory; 2) cognitive therapy as an anxiety regulating technique; 3) behavior therapy as part of defense identification and affect experiencing; and 4) the psychoanalytic relational school as part of affect restructuring and self-other restructuring. Character change occurs through relinquishing defensive behaviors then facing and feeling previously avoided emotions with others. Cognitive, behavioral, and relational techniques are merely means to serve these basic goals. This attempt at a theoretical synthesis is unique in EDT for she is able to show how these theories operate actually at different logical levels. For instance, the conflicts which generate defensive behaviors are at a different logical level than cognitions which are merely a single dimension of the resulting character structure.

Students wanting to learn about the triangle of conflict, how to formulate conflict, and how to generate interventions will find this a very practical and easy to understand book.