Assessing Problematic States in Patients' Narratives: The Grid of Problematic States

The authors present the theoretical background, development, and validation of a new psychotherapy process rating tool: Grid of Problematic States (GPS). The GPS is based on Horowitz's states of mind theory, which describes recurrent patterns of experience and behavior. Meaningful changes in the observed states indicate therapeutic change. The GPS is designed for use with transcripts from psychotherapy sessions and focuses on narrative episodes within the patient dialogue. The GPS was applied to a completely transcribed cognitive psychotherapy with a patient diagnosed as mild major depressive. The authors demonstrated that the GPS could reliably assess disorganization and the development of stable construct clusters of thought themes, emotions, and somatic sensations. The interpretation of results is consistent with the patient's clinical assessment.