Discussion of “Horneyan Developmental Psychoanalytic Theory and its Application to the Treatment of the Young”

In the following, I will present a clinical case illustrating the ideas discussed by Dr. Paul in his paper. First, I wish to emphasize the underlying position held in common by these two monumental thinkers, Drs. Karen Horney and John Bowlby. Essentially, both writers view mental disorder as an effort at coping with an environment experienced as hostile. These words of Dr. Bowlby will seem entirely compatible to Horney theorists: “Psychopathology is regarded as due to a person's psychological development having followed a deviant pathway, and not as due to his suffering a fixation at, or a regression to, some early stage of development” (1, p. 41). Like Fairbairn, Horney and Bowlby regard psychopathology as arising in response to adverse influences in the environment. These adverse influences produce, first, anxiety; only secondarily does hostility to the world develop. This differs from the view held by Melanie Klein in which inner hostility is primary and anxiety seen as fear of retribution.

How might similarities in the work of Bowlby and Horney emerge in a specific clinical case? Serendipitously, I am working in analysis using Karen Horney's orientation with a woman who demonstrates a tetrad described by Dr. Bowlby: (a) compulsive care-giving, (b) illness in the early attachment figure, (c) school phobia by history, and (d) agoraphobia, often associated with bereavement or recent illness (1, pp. 222-224). The phobic symptoms in this tetrad keep the individual at home, and, with the pattern of compulsive caregiving, form a constellation of attachment behaviors mobilized by the perception of a threat to affectional bonds. How these emerge clinically in the course of analysis, is described in the following synopsis.

Jenny, 41, was referred for consultation by her internist. Over a two-month period, anxiety about leaving her house had intensified. While