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Köhler D, Boegel-Driessen JA, Josupeit J, Issa-Keller SJ, Müller R, Stricker J. Reliability and Validity of the Comprehensive Assessment of Psychopathic Personality-Self-Report-German Version (CAPP-SR-GV) in a German Non-Criminal Sample. Behav Sci (Basel) 2024; 14:827. [PMID: 39336042 PMCID: PMC11428708 DOI: 10.3390/bs14090827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/02/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
The structure of psychopathy is conceptualized differently in various models and no consensus has yet been reached. This study aimed to further clarify psychopathy's content and structure by validating the German Comprehensive Assessment of Psychopathic Personality-Self-Report (CAPP-SR). For this purpose, we used a sample of n = 458 participants. The CAPP's six factors were replicated in an exploratory factor analysis. Further confirmatory analysis revealed recommendations for optimizing the CAPP. Thus, both an optimized version and the original CAPP-SR were examined. The construct validity of both versions was then examined using a different self-rating instrument for psychopathy, the Triarchic Psychopathy Measure. The implications of the findings and further research directions are discussed.
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Affiliation(s)
- Denis Köhler
- Faculty for Social Sciences and Cultural Studies, University for Applied Sciences Düsseldorf, 40489 Düsseldorf, Germany
| | | | - Jan Josupeit
- Faculty of Health and Nursing, University of Applied Sciences Gesundheit/Health Bochum, 44801 Bochum, Germany
| | | | - Romina Müller
- Department of Clinical Psychology, Institute of Experimental Psychology, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Johannes Stricker
- Department of Clinical Psychology, Institute of Experimental Psychology, Heinrich Heine University of Düsseldorf, 40225 Düsseldorf, Germany
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Crichton M, Vu J, Fenesi B. Physical Activity Participation among Children and Youth with Mental Health Symptoms: Clinician Perspectives. CHILDREN (BASEL, SWITZERLAND) 2024; 11:880. [PMID: 39062329 PMCID: PMC11276529 DOI: 10.3390/children11070880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND/OBJECTIVES Physical activity supports mental health and well-being in children and youth. However, there are significant barriers to physical activity participation among individuals impacted by mental health disorders. This study investigates these barriers through the perspective of mental health clinicians who support children and youth. METHODS Fourteen mental health clinicians, including registered professional psychologists, psychotherapists, and social workers, were interviewed in a semi-structured format. Qualitative content analysis was performed to identify key themes, including both barriers and facilitators to physical activity. RESULTS Content analysis revealed that clinicians perceive both internal and external barriers and facilitators to their clients' participation in physical activity. Barriers included intrapersonal factors, such as the presence of depression, anxiety, or eating disorder symptoms; lack of motivation; and negative self-talk, as well as factors related to the influence of caregivers, financial limitations, screen time use, environmental and cultural factors, and lack of time. Facilitators included enjoyment of physical activity, knowledge about the benefits of physical activity, and caregiver participation. CONCLUSIONS Mental health clinicians demonstrated clear knowledge about the barriers to and facilitators of their clients' participation in physical activity. These findings provide valuable insights that can be used to support children and youth experiencing mental health difficulty to access the beneficial effects of physical activity.
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Affiliation(s)
| | | | - Barbara Fenesi
- Faculty of Education, Western University, London, ON N6G 1G7, Canada; (M.C.); (J.V.)
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Tanzilli A, Boldrini T, Carone N, Gualco I, Lingiardi V, Williams R. Patient personality dimensions, relational patterns and therapeutic alliance in clinical practice: An empirical investigation. Clin Psychol Psychother 2023; 30:97-111. [PMID: 35981709 DOI: 10.1002/cpp.2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/03/2022] [Accepted: 08/15/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy. METHODS A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler-Westen Assessment Procedure-200 (SWAP-200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI-T) to evaluate quality of therapeutic alliance. RESULTS Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician-patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance. CONCLUSIONS Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes.
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Affiliation(s)
- Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ivan Gualco
- Center for Individual and Couple Therapy, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Riccardo Williams
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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On the use of positive test strategies when diagnosing mental disorders. Compr Psychiatry 2022; 116:152325. [PMID: 35609443 DOI: 10.1016/j.comppsych.2022.152325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/28/2022] [Accepted: 05/05/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite the adverse impact diagnostic errors can have, clinical interviewing and decision-making in psychiatric practice have received relatively little empirical attention. When diagnosing patients, clinicians tend to fall back on a specific (heuristic) rule of thumb, the positive test strategy, a confirmatory approach that increases the risk of confirmation bias. METHOD AND RESULTS A group of 83 clinical psychologists and psychiatrists was asked to give their diagnostic hypotheses about two vignettes. We found them to self-generate significantly (i.e., p < .01; d = 1.57) more confirming than disconfirming questions to test their initial diagnostic impressions, with supervisors considering significantly more differential diagnoses than the less experienced post-grads/residents. When offered a list of 100 potentially relevant diagnostic queries, the supervisors selected fewer confirming and proportionally more disconfirming themes. CONCLUSIONS Our results demonstrate that irrespective of clinical experience mental-health clinicians indeed tend to use a confirmatory thinking style that contrasts with the stricter principle of falsification. More field-based research on this topic is needed, as well as studies probing whether a systematized diagnostic approach is feasible in psychiatric practice and increases diagnostic accuracy and patient satisfaction.
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Mulay AL, Lenger KA, Waugh MH, Cain NM, Florimbio AR, Gottfried ED, Lenzenweger MF, Lewis KC, Shier EK. Contributions of Multimethod Personality Assessment in Indirect Evaluation. J Pers Assess 2022:1-12. [PMID: 35771230 DOI: 10.1080/00223891.2022.2090370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Indirect assessment is a useful tool in forensic evaluation, especially in cases of threat assessment. To this end, we illustrated the ability to conceptualize a complicated case (i.e., Theodore John Kaczynski) using an indirect approach, with a particular emphasis upon dimensional frameworks of personality. Raters who were unrelated to Mr. Kaczynski's case and with expertise in relevant domains were asked to study information available in the public domain about Mr. Kaczynski and provide ratings using several assessment instruments. Our aim was not to provide a professional clinical opinion, but rather engage in scholarly discourse about the utility of instruments. Mr. Kaczynski was rated to demonstrate characteristics associated with lone actor terrorists. He showed an elevation on a measure of psychosis, and raters conceptualized trauma as an important aspect of his functioning. He demonstrated impairments in detachment and psychoticism (Criterion B of the AMPD) and interpersonal functioning (Criterion A of the AMPD). Clinical conceptualizations for Mr. Kaczynski emphasized schizotypal and paranoid personality disorders. This analysis of an infamous case about which considerable data are publicly available demonstrates the ease with which indirect and multimethod assessment can be applied and integrated in forensic assessment, using modern conceptualizations of personality pathology.
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Affiliation(s)
- Abby L Mulay
- Department of Psychiatry and Behavioral Sciences, Community and Public Safety Psychiatry Division, Medical University of South Carolina
| | | | - Mark H Waugh
- Department of Psychology, University of Tennessee, Knoxville
| | - Nicole M Cain
- Graduate School of Applied and Professional Psychology, Rutgers University
| | | | - Emily D Gottfried
- Department of Psychiatry and Behavioral Sciences, Community and Public Safety Psychiatry Division, Medical University of South Carolina
| | - Mark F Lenzenweger
- Department of Psychology, State University of New York at Binghamton, & Department of Psychiatry, Weill Cornell Medical College
| | | | - Emily K Shier
- College of Humanities & Social Sciences, Grand Canyon University
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Wibbelink CJM, Arntz A, Grasman RPPP, Sinnaeve R, Boog M, Bremer OMC, Dek ECP, Alkan SG, James C, Koppeschaar AM, Kramer L, Ploegmakers M, Schaling A, Smits FI, Kamphuis JH. Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry 2022; 22:89. [PMID: 35123450 PMCID: PMC8817780 DOI: 10.1186/s12888-021-03670-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
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Affiliation(s)
- Carlijn J. M. Wibbelink
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Raoul P. P. P. Grasman
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Roland Sinnaeve
- Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michiel Boog
- Department of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, Rotterdam, 3062 MA the Netherlands
- Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Odile M. C. Bremer
- Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, Amsterdam, 1093 MB the Netherlands
| | - Eliane C. P. Dek
- PsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, Rotterdam, 3062 MA the Netherlands
| | | | - Chrissy James
- Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, Amsterdam, 1082 JC the Netherlands
| | | | - Linda Kramer
- GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC Heerhugowaard, the Netherlands
| | | | - Arita Schaling
- Pro Persona, Willy Brandtlaan 20, Ede, 6716 RR the Netherlands
| | - Faye I. Smits
- GGZ Rivierduinen, Sandifortdreef 19, Leiden, 2333 ZZ the Netherlands
| | - Jan H. Kamphuis
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
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Riley AR, Waite LJ, Cagney KA. Novel Insights From Interviewer Assessments of Personal Attributes, Home Environment, and Residential Context in NSHAP. J Gerontol B Psychol Sci Soc Sci 2021; 76:S322-S334. [PMID: 34918154 PMCID: PMC8678430 DOI: 10.1093/geronb/gbab176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study was aimed to describe the interviewer-assessed measures present in the 2015/2016 Round of National Social Life, Health, and Aging Project (NSHAP), outline strengths of interviewer-assessed measures, and explore how interviewer assessments in the domains of home environment and personal characteristics are associated with older adult health. METHOD Data come from the 2015/2016 Round of the NSHAP. RESULTS We provide descriptive results from the interviewer assessments of personal attributes, indoor home environment, and outdoor residential context. We present an illustrative analysis of reports of falls, a health outcome that might be predicted by characteristics assessed by the interviewer, and we suggest directions for further research. DISCUSSION Interviewer assessments collected in NSHAP are useful as proxy measures and can be used in combination with respondent's reports and ecological measures to generate insights into healthy aging.
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Affiliation(s)
- Alicia R Riley
- Department of Sociology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Linda J Waite
- Department of Sociology, University of Chicago, Chicago, Illinois, USA
| | - Kathleen A Cagney
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Levis M, Levis A. Contrasting narratives: a randomised control study comparing Conflict Analysis and narrative disclosure. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2021. [DOI: 10.1080/03069885.2021.1970111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maxwell Levis
- White River Junction VA Medical Center, Hartford, VT, USA
- Psychiatry Department, Dartmouth College, Hanover, NH, USA
- Museum of the Creative Process, Manchester, VT, USA
| | - Albert Levis
- Museum of the Creative Process, Manchester, VT, USA
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Luyten P, Fonagy P. Integrating and differentiating personality and psychopathology: A psychodynamic perspective. J Pers 2021; 90:75-88. [PMID: 34170512 DOI: 10.1111/jopy.12656] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/18/2023]
Abstract
Several strands of research converge to suggest that personality and psychopathology can be integrated in the form of a hierarchical model of individual differences. The notion that personality and psychopathology are intrinsically linked has a long tradition within psychodynamic approaches. In this article, we first summarize empirical evidence supporting two related key assumptions of psychodynamic approaches to personality and psychology: that a developmental, person-centered approach is needed to complement a static, disorder-centered approach in the conceptualization and treatment of psychopathology; and that personality and psychopathology are best conceptualized as dynamic attempts at adaptation. Research in each of these areas supports the notion that personality and psychopathology are difficult to separate and may be moderated by severity (i.e., general psychopathology) such that increasing levels of severity result in increased intrinsic coupling between the two. We then discuss these findings in the context of a newly emerging social-communicative approach to human development that suggests that personality and psychopathology are better conceptualized in terms of a disorder of social communication, and that the purported rigidity and stability typically attributed to them are largely explained by the stability of the environmental mechanisms that underpin them, rather than by stable intrapersonal traits. The implications of these new views for the future of the science of personality and psychopathology, and for treatment strategies, are discussed.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Fortunato A, Tanzilli A, Lingiardi V, Speranza AM. Childhood Personality Assessment Q-Sort (CPAP-Q): A Clinically and Empirically Procedure for Assessing Traits and Emerging Patterns of Personality in Childhood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6288. [PMID: 34200700 PMCID: PMC8296064 DOI: 10.3390/ijerph18126288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite increasing research confirming the existence of childhood personalities, which are recognizable from a developmental perspective, controversies over the possibility to assess personality in childhood have continued. The purpose of this study was to provide initial data on the validation of the Childhood Personality Assessment Q-Sort (CPAP-Q), a clinician report instrument that can be employed to evaluate children's personalities and address the gap in the field of emerging personality in children classification. METHOD A sample of 135 clinicians completed the CPAP-Q to assess the personality features of 135 children (ages 4-11) who had been in their care between two and 12 months. The clinicians completed a clinical questionnaire to collect information on them, the children, and their families, as well as the Child Behavior Checklist (CBCL), to evaluate the children's behavioral problems and social competencies. RESULTS Q-factor analysis identified seven specific emerging personality patterns: psychological health, borderline/impulsive, borderline/dysregulated, schizoid, inhibited/self-critical, obsessive, and dysphoric/dependent. These patterns revealed good levels of validity and reliability. CONCLUSIONS These findings are preliminary, but seem to support the possibility of evaluating emerging personality patterns in childhood and their developmental pathways that may lead to personality disorders in adolescence and adulthood. The CPAP-Q promises to significantly contribute to less explored research areas and encourage systematic studies of children assessment, promoting best practices for individualized diagnoses.
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Affiliation(s)
- Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, “Sapienza”, University of Rome, Via Degli Apuli, 1, 00185 Rome, Italy; (A.T.); (V.L.); (A.M.S.)
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Levis M, Levis AJ. Contextual assessment: evaluating a novel self-guided online therapeutic assessment. Int J Psychiatry Clin Pract 2021; 25:206-215. [PMID: 32701050 PMCID: PMC11151187 DOI: 10.1080/13651501.2020.1794010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/20/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Paper introduces Conflict Analysis (CA), an online self-guided therapeutic assessment. CA combines a diagnostic self-report scale with narrative exercises and self-analytical tasks. CA automatically generates detailed diagnostic records and frameworks for changes. OBJECTIVE To evaluate therapeutic and diagnostic benefits associated with CA over time. METHODS This online study compared CA over 2 weeks on outcome measures predicting psychotherapy outcome. Novel scale measuring perceived diagnostic benefit and perceived therapeutic benefit was delivered at post and follow-up. Cohort (n = 59, average age = 35, 50% female) was either in therapy or interested to start therapy in near future. RESULTS Repeated-measure ANOVAs suggest that scores significantly changed on measures predicting negative affect, depression, performance and appearance self-esteem, insight, and growth initiative. Agreement rates on items measuring perceived diagnostic and therapeutic benefits were at least 74.5% for both post and follow-up. CONCLUSIONS Evidence supports further exploration of CA as a self-guided diagnostic and therapeutic resource.Key pointsResults demonstrate feasibility and utility of online self-guided therapeutic assessment.Described model is associated with increased perceived diagnostic and therapeutic benefits.Described model illustrates therapeutic benefits over time.Results demonstrate that even self-guided assessment can have therapeutic implications.
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Affiliation(s)
- Maxwell Levis
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Museum of the Creative Process, Manchester, VT, USA
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Zammit AR, Bennett DA, Hall CB, Lipton RB, Katz MJ, Muniz-Terrera G. A Latent Transition Analysis Model to Assess Change in Cognitive States over Three Occasions: Results from the Rush Memory and Aging Project. J Alzheimers Dis 2021; 73:1063-1073. [PMID: 31884467 DOI: 10.3233/jad-190778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Conceptualizing cognitive aging as a step-sequential process is useful in identifying particular stages of cognitive function and impairment. OBJECTIVE We applied latent transition analysis (LTA) to determine 1) whether the underlying structure of cognitive profiles found at every measurement occasion are uniform across three waves of assessment, 2) whether class-instability is predictive of distal outcomes, and 3) whether class-reversions from impaired to non-impaired using latent modelling is lower than when using clinical criteria of mild cognitive impairment (MCI). METHODS A mover-stayer LTA model with dementia as a distal outcome was specified to model transitions of ten neuropsychological measures over three annual waves in the Rush Memory and Aging Project (n = 1,661). The predictive validity of the mover-stayer status for incident Alzheimer's disease (AD) was then assessed. RESULTS We identified a five-class model across the three time-points: Mixed-Domain Impairment, Memory-Specific Impairment, Frontal Impairment, Average, and Superior Cognition. None of the individuals in the Impairment classes reverted to the Average or Superior classes. Conventional MCI classification identified 26.4% and 14.1% at Times 1 and 2 as false-positive cases. "Movers" had 87% increased risk of developing dementia compared to those classified as "Stayers". CONCLUSION Our findings support the use of latent variable modelling that incorporates comprehensive neuropsychological assessment to identify and classify cognitive impairment.
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Affiliation(s)
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Mindy J Katz
- Albert Einstein College of Medicine, Bronx, NY, USA
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Muzi L, Tieghi L, Rugo MA, Lingiardi V. Personality as a predictor of symptomatic change in a residential treatment setting for anorexia nervosa and bulimia nervosa. Eat Weight Disord 2021; 26:1195-1209. [PMID: 33048329 PMCID: PMC8062347 DOI: 10.1007/s40519-020-01023-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Although personality has been widely researched in patients with anorexia nervosa (AN) and bulimia nervosa (BN), the nature of this relationship has not yet been clearly articulated. The pathoplasty model theorizes that personality might shape symptomatic presentation and thus affect therapeutic outcomes, but more research is needed. The present study aimed at investigating the predictive value of a broad spectrum of personality traits in determining AN and BN treatment outcomes, considering both the statistical and clinical significance of the therapeutic change. METHODS Eighty-four female patients with AN and BN treated in a residential program were evaluated at treatment onset using the Shedler-Westen Assessment Procedure-200-a clinician-rated measure of personality disorders and healthy personality functioning. At both intake and discharge, patients completed the Eating Disorder Inventory-3 to assess eating symptoms and the Outcome Questionnaire-45.2 to evaluate overall impairment. RESULTS Considering overall ED symptomatic change, multiple regression analyses showed that, even when controlling for baseline symptoms and DSM-5 categories, schizoid (B = 0.41, p ≤ 0.01), avoidant (B = 0.31, p ≤ 0.05), and paranoid (B = 0.25, p ≤ 0.05) personality features predicted worse therapeutic outcomes. Similar results were found when applying the clinical significance approach, with the emotionally dysregulated factor as an additional negative predictor of significant/reliable change (B = - 0.09; p < 0.01). Healthy personality functioning predicted better therapeutic outcomes (B = - 0.34, p ≤ 0.001). CONCLUSIONS Pathoplastic models and personality-based research in this clinical population have the potential to inform effective treatment strategies by targeting relevant individual factors. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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Affiliation(s)
- Laura Muzi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185, Rome, Italy.
| | - Laura Tieghi
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | | | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185, Rome, Italy
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Negri A, Andreoli G, Mariani R, De Bei F, Rocco D, Greco A, Bucci W. First Validation of the Referential Process Post-Session Scale - Therapist Version (RPPS-T). CLINICAL NEUROPSYCHIATRY 2020; 17:319-329. [PMID: 34909010 PMCID: PMC8662713 DOI: 10.36131/cnfioritieditore20200601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Bucci's multiple code theory maintains that for a significant change the patient-therapist relationship should foster a referential process shaping in three alternating phases: arousal of emotion schemas, symbolizing/narrating emotional experiences, and reflecting/reorganizing the emotional meanings. Until now to monitor these phases clinicians and researchers have used several referential process computerized linguistic measures, which however need the sessions verbatim transcription. In order to have a less time-consuming method we developed and tested a therapist self-report questionnaire measuring the referential process phases. METHOD We asked eight psychotherapists in a first study and nine psychotherapists in a second study to complete the Referential Process Post-session Scale - Therapist version (RPPS-T) just after the end of their sessions. In a third study we transcribed 29 sessions conducted by three psychotherapists to calculate the correlations between the RPPS-T scores and the computerized linguistic measures of the referential process calculated on the session transcripts. RESULTS In the first study we collected 105 evaluations regarding 29 patients and an exploratory factor analysis revealed a four-factor pattern consistent with the hypothesized constructs. The analysis reduced the initial pool of 42 items to 12. In the second study 130 sessions with 25 different patients have been evaluated on the shortened version of the RPPS-T and a confirmatory factor analysis found that the four-factor model satisfactorily fitted the new data as well. In the third study we found that the factors of RPPS-T regarding the symbolizing phase correlated with the corresponding computerized linguistic measures calculated on the session transcripts. CONCLUSIONS The RPPS-T received a first validation as a concurrent measure of the referential process, especially for the symbolizing phase, and could be considered a useful instrument for research and supervision.
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Affiliation(s)
- Attà Negri
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Rachele Mariani
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Francesco De Bei
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Diego Rocco
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Wilma Bucci
- New York Psychoanalytic Society and Institute, New York, NY, USA
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15
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Gagliardini G, Gatti L, Colli A. Further data on the reliability of the mentalization imbalances scale and of the modes of mentalization scale. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:450. [PMID: 32913829 PMCID: PMC7451392 DOI: 10.4081/ripppo.2020.450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/08/2020] [Indexed: 12/02/2022]
Abstract
The aim of this study was to provide data on the Inter-Rater Reliability (IRR) and the test-retest reliability of the Mentalization Imbalances Scale (MIS) and the Modes of Mentalization Scale (MMS) in two different studies. Three junior raters and two senior raters assessed blindly 15 session transcripts of psychotherapy of five patients, using both the MIS and the MMS. The same 15 sessions were rated after the junior raters completed a training at the use of the scales and after on month from the end of the training to assess testretest reliability. Four therapists used the MIS and the MMS to provide different ratings of 22 patients undergoing a psychotherapy in different settings. Intraclass Correlation Coefficient (ICC) values ranged from sufficient to good and increased after the training. Test re-test reliability was sufficient for both scales (Study 1). ICC values ranged from sufficient to good, and were globally higher than the ones found in the first study sample (Study 2). Our results provide support to the inter-rater reliability of the MIS and the MMS.
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Affiliation(s)
| | | | - Antonello Colli
- Department of Humanites, "Carlo Bo" Univeristy of Urbino, Italy
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16
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Tanzilli A, Gualco I. Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation. J Pers Disord 2020; 34:42-62. [PMID: 32186983 DOI: 10.1521/pedi.2020.34.supp.42] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined clinician emotional responses and therapeutic alliance in psychotherapy with adolescent patients with specific subtypes of narcissistic personality disorder (NPD). A national sample of therapists (N = 58) completed the Therapist Response Questionnaire for Adolescents to identify patterns of clinician response, the Working Alliance Inventory to evaluate the quality of alliance, and the Shedler-Westen Assessment Procedure-II for Adolescents to assess the personality pathology of a patient in their care. The results showed that the grandiose narcissistic subtype was positively related to angry/criticized and disengaged/hopeless therapist responses and negatively related to warm/attuned response. The fragile subtype was positively related to overinvolved/worried therapist response. The high-functioning/exhibitionistic subtype was negatively related to angry/criticized response. Lower quality of therapeutic alliance was positively associated with the grandiose subtype. Moreover, the empirically founded prototypes of therapist responses to adolescent patients with NPD subtypes strongly resemble theoretical-clinical accounts. The clinical implications are addressed.
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Affiliation(s)
- Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Ivan Gualco
- Center for Individual and Couple Therapy, Genoa, Italy
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17
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Wakschlag LS, Krogh-Jespersen S, Estabrook R, Hlutkowsky CO, Anderson EL, Burns J, Briggs-Gowan MJ, Petitclerc A, Perlman SB. The Early Childhood Irritability-Related Impairment Interview (E-CRI): A Novel Method for Assessing Young Children's Developmentally Impairing Irritability. Behav Ther 2020; 51:294-309. [PMID: 32138939 PMCID: PMC10127521 DOI: 10.1016/j.beth.2019.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
Irritability is a substrate of more than one dozen clinical syndromes. Thus, identifying when it is atypical and interfering with functioning is crucial to the prevention of mental disorder in the earliest phase of the clinical sequence. Advances in developmentally based measurement of irritability have enabled differentiation of normative irritable mood and tantrums from indicators of concern, beginning in infancy. However, developmentally sensitive assessments of irritability-related impairment are lacking. We introduce the Early Childhood Irritability-Related Impairment Interview (E-CRI), which assesses impairment associated with irritable mood and tantrums across contexts. Reliability and validity are established across two independent samples varied by developmental period: the Emotional Growth preschool sample (EmoGrow; N = 151, M = 4.82 years) and the When to Worry infant/toddler sample (W2W; N = 330, M = 14 months). We generated a well-fitting two-factor E-CRI model, with tantrum- and irritable mood-related impairment factors. The E-CRI exhibited good interrater, test-retest, and longitudinal reliability. Construct and clinical validity were also demonstrated. In both samples, E-CRI factors showed association to internalizing and externalizing problems, and to caregiver-reported concern in W2W. Tantrum-related impairment demonstrated stronger and more consistent explanatory value across outcomes, while mood-related impairment added explanatory utility for internalizing problems. The E-CRI also showed incremental utility beyond variance explained by the Family Life Impairment Scale (FLIS) survey indicator of developmental impairment. The E-CRI holds promise as an indicator of impairment to inform identification of typical versus atypical patterns reflecting early emerging irritability-related syndromes in the initial phase of the clinical sequence.
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Affiliation(s)
- Lauren S Wakschlag
- Northwestern University Feinberg School of Medicine and Institute for Innovations in Developmental Sciences.
| | - Sheila Krogh-Jespersen
- Northwestern University Feinberg School of Medicine and Institute for Innovations in Developmental Sciences
| | | | | | | | | | | | - Amélie Petitclerc
- Northwestern University and Institute for Innovations in Developmental Sciences
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18
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Waugh MH, McClain CM, Mariotti EC, Mulay AL, DeVore EN, Lenger KA, Russell AN, Florimbio AR, Lewis KC, Ridenour JM, Beevers LG. Comparative Content Analysis of Self-Report Scales for Level of Personality Functioning. J Pers Assess 2020; 103:161-173. [PMID: 31917602 DOI: 10.1080/00223891.2019.1705464] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Content validity analyses of eight self-report instruments for assessing severity of personality disorder (PD), also known as Level of Personality Functioning (LPF), were conducted using the conceptual scheme of the Alternative Model for Personality Disorders (AMPD; APA, 2013). The item contents of these eight inventories were characterized for the LPF constructs of Identity (ID), Self-Direction (SD), Empathy (EM), and Intimacy (IN) along with the pathological personality trait domains of Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism. Severity of pathology (SV) reflected in item content was also rated. Raters demonstrated robust agreement for AMPD and SV constructs across instruments. Similarity between instrument AMPD construct profiles was quantified by intraclass correlations (ICC). Results showed the instruments were generally similar in AMPD-construct coverage, but some important differences emerged. The subscales of the instruments also were characterized for the degree to which they reflect the four LPF (ID, SD, EM, IN) domain constructs. Collectively, these content validity comparisons clarify the equivalence of instruments for AMPD constructs and the relative proportions of construct coverage within instrument subscales. These results can inform future research with LPF self-report instruments and guide clinicians in selecting an LPF-related instrument for use in practice.
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Affiliation(s)
- Mark H Waugh
- Oak Ridge National Laboratory.,University of Tennessee, Knoxville
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19
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Boldrini T, Tanzilli A, Di Cicilia G, Gualco I, Lingiardi V, Salcuni S, Tata MC, Vicari S, Pontillo M. Personality Traits and Disorders in Adolescents at Clinical High Risk for Psychosis: Toward a Clinically Meaningful Diagnosis. Front Psychiatry 2020; 11:562835. [PMID: 33363479 PMCID: PMC7753018 DOI: 10.3389/fpsyt.2020.562835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022] Open
Abstract
Aims: Recent meta-analytic data show that approximately 40% of individuals at clinical high risk for psychosis (CHR) receive at least one personality disorder (PD) diagnosis. Personality pathology could significantly influence CHR patients' prognosis and response to treatment. We aimed at exploring the PD traits of CHR adolescents, in order to outline a prototypic description of their most frequently observed personality characteristics. Methods: One hundred and twenty-three psychiatrists and psychologists used a Q-sort procedure [i.e., the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A)] to assess personality traits and disorders in 58 (30 male; mean age = 16 years, range = 13-19 years) CHR adolescents and two gender- and age-matched samples, respectively, with (n = 60) and without PDs (n = 59). Results: Differences between the CHR, PD, and clinical groups showed that CHR adolescents had pervasive and more clinically relevant schizoid, schizotypal, borderline, and avoidant traits, as well as poorer adaptive functioning. Moreover, by collecting the highest mean SWAP-200-A items, we empirically outlined a prototypic description of CHR youths, comprised of avoidance of social relationships; suspiciousness; obsessional thoughts; lack of psychological insight; dysphoric and overwhelming feelings of anxiety and depression; odd and anomalous reasoning processes or perceptual experiences; symptoms of depersonalization and derealization; and negative symptoms of avolition, abulia, blunted affects, and impaired role functioning. Conclusions: The results suggest that avoidant interpersonal strategies, impaired mentalization, and difficulties in emotional regulation could become important targets for psychosocial interventions with CHR adolescent populations.
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Affiliation(s)
- Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Di Cicilia
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Ivan Gualco
- Center for Individual and Couple Therapy, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Maria Cristina Tata
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesú, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesú, IRCCS, Rome, Italy.,Department of Life Sciences and Public Health, Catholic University, Rome, Italy
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesú, IRCCS, Rome, Italy
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20
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Faccini F, Gazzillo F, Gorman BS. Guilt, Shame, Empathy, Self-Esteem, and Traumas: New Data for the Validation of the Interpersonal Guilt Rating Scale-15 Self-Report (IGRS-15s). Psychodyn Psychiatry 2020; 48:79-100. [PMID: 32202981 DOI: 10.1521/pdps.2020.48.1.79] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The aim of this paper is to present further data for the validation of the Interpersonal Guilt Rating Scale-15 self-report (IGRS-15s; Gazzillo et al., 2018). We recruited a sample of 448 subjects, to whom we administered the IGRS-15s together with other empirically validated measures for the assessment of social desirability, shame, self-esteem, empathy, mental health and therapeutic alliance. In line with our hypotheses, the previously established three-factor structure of the IGRS-15s (Survivor guilt, Omnipotence guilt, and Self-hate) was confirmed. Moreover, the internal consistency and test-retest reliability of IGRS-15s were adequate to good. All the IGRS-15s factors were negatively correlated with self-esteem and mental health and positively correlated with shame; Survivor guilt and Omnipotence guilt were positively correlated with empathy; Survivor guilt and Self-hate negatively affected therapeutic alliance; and different traumas had different, theoretically predictable, impacts on the different kinds of guilt. Overall, these data support the reliability and validity of the IGRS-15s.
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Affiliation(s)
- Filippo Faccini
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome
| | - Francesco Gazzillo
- Derner Institute of Advanced Psychology Studies, Adelphi University, Long Island, New York
| | - Bernard S Gorman
- Derner Institute of Advanced Psychology Studies, Adelphi University, Long Island, New York
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21
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Hausam J, Lehmann RJB, Dahle KP. A Person-Centered Approach to Prison Behavior Based on Officers' Observations: Relations to Risk, Prison Misconduct, and Recidivism. Front Psychiatry 2020; 11:241. [PMID: 32308633 PMCID: PMC7145960 DOI: 10.3389/fpsyt.2020.00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/12/2020] [Indexed: 12/02/2022] Open
Abstract
Incorporating measures of prison behavior into risk assessment and management procedures may assist in treatment planning, risk monitoring, and decision-making. A behavior rating scale was used to assess prison officers' observations on externalizing, internalizing, and adaptive behavior in a sample of 277 sexual and violent offenders in correctional treatment in Berlin, Germany. The present study employed latent profile analysis to identify inmate subtypes with similar behavioral patterns. Results indicated a solution with five latent profiles that showed similarities with previous inmate typologies. The subtypes were termed "Aggressive-Psychopathic," "Asocial," "Situational," "Inconspicuous, and "Inadequate-Dependent." Analyses attested to the construct and predictive validity of the subtypes and involved the examination of differences on criminological characteristics, risk assessment instruments, various types of prison misconduct, and postrelease recidivism. This person-centered study illustrates the importance of attending to broader patterns of inmate behavior. The structured assessment of behavioral observations by prison officers can be a valuable and easy-to-implement approach to benefit from this largely neglected resource.
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Affiliation(s)
- Joscha Hausam
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Klaus-Peter Dahle
- Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychology, University of Hildesheim, Hildesheim, Germany
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22
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Tanzilli A, Gualco I, Baiocco R, Lingiardi V. Clinician Reactions When Working with Adolescent Patients: The Therapist Response Questionnaire for Adolescents. J Pers Assess 2019; 102:616-627. [PMID: 31609644 DOI: 10.1080/00223891.2019.1674318] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examined the factor structure and psychometric properties of the Therapist Response Questionnaire for Adolescents (TRQ-A), an 86-item clinician-report instrument measuring a wide range of thoughts, feelings, and behaviors expressed by therapists toward their adolescent patients. A sample of psychodynamic and cognitive-behavioral clinicians (N = 192) filled in the TRQ-A and the latest version of the Shedler-Westen Assessment Procedure for Adolescents (SWAP-II-A) in order to assess the personality styles/disorders of a randomly selected adolescent patient in their care. Factor analysis identified six conceptually coherent and internally consistent countertransference patterns: warm/attuned, angry/criticized, disorganized/frightened, overinvolved/worried, disengaged/hopeless, and sexualized. These patterns were significantly related to patients' personality styles/disorders in a clinically meaningful and systematically predictable manner. The results support the TRQ-A's validity and internal reliability in evaluating the complex portrait of multifaceted reactions that clinicians typically experience toward adolescent patients, and its potential to improve diagnostic accuracy and guide clinicians in planning effective therapeutic interventions. The TRQ-A promises to significantly contribute to this less explored research area and encourage systematic studies of youth treatment, promoting best practice for successful therapeutic outcomes.
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Affiliation(s)
- Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Ivan Gualco
- Psicoterapy, Center for Individual and Couple Therapy, Genoa, Italy
| | - Roberto Baiocco
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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23
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Personality and Personality Disorders in Medication-Overuse Headache: A Controlled Study by SWAP-200. Pain Res Manag 2019; 2019:1874078. [PMID: 31281555 PMCID: PMC6594272 DOI: 10.1155/2019/1874078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/04/2019] [Indexed: 12/17/2022]
Abstract
Background Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved in MOH development has been advanced but was poorly studied. The hypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings. Objectives This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect. Methods Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender. Results MOH patients were predominantly women and older. They showed lower traits of the SWAP-200's cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200's cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients. Conclusion Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drug-addicted and personality-disordered patients were found. Practitioners' careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs.
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24
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Boldrini T, Tanzilli A, Pontillo M, Chirumbolo A, Vicari S, Lingiardi V. Comorbid Personality Disorders in Individuals With an At-Risk Mental State for Psychosis: A Meta-Analytic Review. Front Psychiatry 2019; 10:429. [PMID: 31333509 PMCID: PMC6625011 DOI: 10.3389/fpsyt.2019.00429] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/31/2019] [Indexed: 12/19/2022] Open
Abstract
Increasing evidence shows that personality pathology is common among patients at clinical high risk (CHR) for psychosis. Despite the important impact that this comorbidity might have on presenting high-risk psychopathology, psychological functioning, and transition to full psychotic disorders, the relationship between personality syndromes and CHR state has received relatively little empirical attention. The present meta-analytic review aimed at 1) estimating the prevalence rates of personality disorders (PDs) in CHR individuals and 2) examining the potential role of PDs in predicting transition from CHR state to a full-blown psychotic disorder. The systematic search of the empirical literature identified 17 relevant studies, including a total of 1,868 CHR individuals. Three distinct meta-analyses were performed to provide prevalence estimates of PDs in the CHR population. The first and more comprehensive meta-analysis focused on any comorbid PD (at least one diagnosis), the second one focused on schizotypal personality disorder (SPD), and the last one focused on borderline personality disorder (BPD). Moreover, a narrative review was presented to define the predictive role of personality disorders in promoting more severe outcomes in CHR patients. The findings showed that the prevalence rate of personality disorders in CHR patients was 39.4% (95% CI [26.5%-52.3%]). More specifically, 13.4% (95% CI [8.2%-18.5%]) and 11.9% (95% CI [0.73%-16.6%]) of this clinical population presented with SPD and BPD, respectively. Finally, the studies examining the effects of baseline personality diagnoses on conversion to psychotic disorders showed contradictory and insufficient results concerning the potential significant impact of SPD. Conversely, no effect of BPD was found. This meta-analytic review indicated that the CHR population includes a large subgroup with serious personality pathology, that may present with attenuated psychotic symptoms conjointly with distinct and very heterogeneous personality features. These findings support the need for improved understanding of both core psychological characteristics of CHR patients and differentiating aspects of personality that could have relevant clinical implications in promoting individualized preventive interventions and enhancing treatment effectiveness.
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Affiliation(s)
- Tommaso Boldrini
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Antonio Chirumbolo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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25
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Gagliardini G, Gullo S, Caverzasi E, Boldrini A, Blasi S, Colli A. Assessing mentalization in psychotherapy: first validation of the Mentalization Imbalances Scale. RESEARCH IN PSYCHOTHERAPY (MILANO) 2018; 21:339. [PMID: 32913774 PMCID: PMC7451352 DOI: 10.4081/ripppo.2018.339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/05/2018] [Indexed: 11/23/2022]
Abstract
The aim of this study was to provide data on the preliminary validation of a clinician-report multidimensional assessment measure of mentalization (Mentalization Imbalances Scale, MIS). A random national sample of psychotherapists (N=190) completed the MIS to identify mentalization imbalances, and the Personality Disorder Checklist to assess the personality disorders (PDs) of randomly selected patients currently in their care. Factor analysis confirmed the presence of six factors that represented different imbalances of mentalization: cognitive, affective, automatic, external, imbalance toward others, and imbalance toward self. We found several significant relationships between patients' mentalization imbalances and personality pathology. Paranoid, schizoid, and schizotypal PDs were predicted by an imbalance toward self, an imbalance the patients shared with histrionic, avoidant, and obsessive compulsive PDs, whereas dependent, borderline, and histrionic PDs were related to an imbalance toward others. Cognitive imbalance was related to schizoid, narcissistic, and obsessive compulsive PDs, whereas affective imbalance predicted antisocial, borderline, narcissistic and histrionic PDs. Automatic imbalance was related to schizotypal, antisocial, and borderline PDs. MIS represents a reliable and valid measure that can help clinicians at understanding patients' specific difficulties of mentalization.
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Affiliation(s)
| | - Salvatore Gullo
- Department of Psychology and Educational Sciences, University of Palermo
| | - Edgardo Caverzasi
- Department of Brain and Behavioural Sciences, University of Pavia, Italy
| | - Annalisa Boldrini
- Department of Brain and Behavioural Sciences, University of Pavia, Italy
| | - Stefano Blasi
- Department of Humanities, “Carlo Bo” University of Urbino
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26
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Nakash O, Nagar M, Bentov-Gofrit D, Md E, Amiaz R, Lev-Ran S, Westen D. Validity and clinical utility of DSM and prototype diagnosis for depressive and anxiety spectrum disorders in predicting adaptive functioning. Psychiatry Res 2018; 270:50-56. [PMID: 30243132 DOI: 10.1016/j.psychres.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 05/29/2018] [Accepted: 09/05/2018] [Indexed: 11/19/2022]
Abstract
Prototype matching, which involves comparing a patient clinical presentation with a prototype description of the disorder, addresses some of the clinical limitations of categorical approaches. Most research to-date on prototype matching has been conducted with personality disorders. Here, we examined the validity and clinical utility of prototype diagnosis for mood and anxiety disorders. We compared clinicians prototype diagnosis (based on DSM IV and empirically derived) to categorical diagnosis (based on independent SCID interview) in predicting patient global adaptive functioning rated across the clinician, patient and independent interviewer among N = 80 clinicians and N = 170 patients. Our findings show that prototype diagnosis (both one that is based on DSM criteria and empirically derived) demonstrates some incremental validity over and above the categorical DSM IV, in predicting patient's global adaptive functioning. This is particularly pronounced for mood disorders (MDD and dysthymia) as well as several anxiety disorders (OCD, social phobia) across a range of experience level of diagnosticians. Furthermore, clinicians rated the prototype matching approach as more useful in clinical practice compared with the binary categorical system. Using a dimensional approach, which is based on prototype matching that also preserves the advantages of categorical system offers a valid and efficient approach to psychiatric assessment.
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Affiliation(s)
- Ora Nakash
- School of Psychology, Interdisciplinary Center (IDC), P.O.Box 167, Herzliya 46150, Israel.
| | - Maayan Nagar
- School of Psychology, Interdisciplinary Center (IDC), P.O.Box 167, Herzliya 46150, Israel
| | | | - Evelyne Md
- Hanotrim Mental Health Clinic, Shalvata Mental Health Center, Raanana, Israel
| | - Rvital Amiaz
- Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Shaul Lev-Ran
- Lev Hasharon Medical Center, Netanya, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Drew Westen
- Department of Psychology and Psychiatry, Emory University, Atlanta, GA, United States
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Nagar M, Westen D, Nakash O. Reliability of DSM and empirically derived prototype diagnosis for mood, anxiety and personality disorders. Compr Psychiatry 2018; 85:8-14. [PMID: 29933136 DOI: 10.1016/j.comppsych.2018.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/11/2018] [Accepted: 06/02/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prominent psychiatric diagnostic systems such as the DSM-IV and ICD-10 have shown low reliability in clinical practice. An alternative approach to classification of psychiatric disorders is prototype matching. In the current study, we examined reliability of assessing mood, anxiety and personality disorders using a multi-method multi informant approach. More specifically, we examined diagnosis made by treating clinician and independent expert clinical interviewer, using three different diagnostic systems (DSM symptom count, DSM-IV prototype diagnosis and empirically derived prototype diagnosis). METHODS A convenience sample of clinicians (N = 80) and patients (N = 170) from eight community mental health clinics in Israel participated in the study. RESULTS Our findings show fair to excellent interrater reliability for prototype dimensional diagnostic systems (ranged from 0.40 to 0.79) for most mood and anxiety disorders examined. Overall, dimensional diagnostic systems, yielded better interrater reliability for mood, anxiety and personality disorders, as compared with categorical diagnosis. There were no significant differences between dimensional systems. CONCLUSIONS Our findings provide further support to the advantages of dimensional over categorical models in increasing reliability.
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Affiliation(s)
- Maayan Nagar
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, P.O. Box 167, Herzliya 46150, Israel.
| | - Drew Westen
- Department of Psychology and Psychiatry, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, P.O. Box 167, Herzliya 46150, Israel.
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Abstract
We examined the interrater reliability and diagnostic efficiency of clinician report (both the treating clinician and independent expert clinical interviewer) and patient self-report of clinically meaningful information pertaining to adaptive functioning. A convenience sample of clinicians (N = 80) and patients (N = 170) from eight community mental health clinics in Israel participated in the study. Our findings suggest that clinicians overall reliably report on adaptive functioning of patients (overall correct classification rates range, 0.74-0.98). Yet, in some areas, they may fail to collect necessary information such as self-mutilation history, loss of job in the past 5 years, and adult physical abuse. The patterns of higher versus lower diagnostic efficiency suggest that both treating clinicians and independent clinician interviewers tend to make judgments conservatively, essentially sacrificing sensitivity for specificity, not diagnosing events unless they were certain, thus maximizing false-negatives and minimizing false-positives.
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Hausam J, Lehmann RJB, Dahle KP. Predicting Offenders' Institutional Misconduct and Recidivism: The Utility of Behavioral Ratings by Prison Officers. Front Psychiatry 2018; 9:679. [PMID: 30618861 PMCID: PMC6295560 DOI: 10.3389/fpsyt.2018.00679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/23/2018] [Indexed: 12/02/2022] Open
Abstract
Measures of current behavior are rarely incorporated into risk assessment. Therefore, the current study used a behavior rating scale to assess prison officers' observations of inmates prison behavior and examined the contribution of these ratings for risk assessment. Prison officers rated 272 sexual and violent offenders in three different correctional treatment facilities in Berlin, Germany. Factor analysis revealed three psychologically meaningful factors measuring externalizing, internalizing and adaptive prison behavior. The construct validity of the three factors was established through correlational analyses with standardized risk assessment instruments. Externalizing and internalizing behaviors were significant predictors of violent recidivism after release. In addition, externalizing was a significant predictor of institutional misconduct, whereas adaptive and internalizing behavior predicted whether an inmate was granted privileges (e.g., minimum-security confinement). Logistic regression analyses indicated that externalizing behavior ratings added incrementally to the Level of Service Inventory-Revised for the prediction of institutional misconduct and violent recidivism. The results indicate that prison officers observe important prison behaviors and that behavioral ratings can improve risk assessment.
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Affiliation(s)
- Joscha Hausam
- Institute of Forensic Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Klaus-Peter Dahle
- Institute of Forensic Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychology, University of Hildesheim, Hildesheim, Germany
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Rost F, Luyten P, Fonagy P. The Anaclitic-Introjective Depression Assessment: Development and preliminary validity of an observer-rated measure. Clin Psychol Psychother 2017; 25:195-209. [DOI: 10.1002/cpp.2153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Felicitas Rost
- Research Department of Clinical, Educational and Health Psychology; University College London; London UK
- Tavistock and Portman NHS Foundation Trust; London UK
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology; University College London; London UK
- University of Leuven; Leuven Belgium
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology; University College London; London UK
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31
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Nazzaro MP, Boldrini T, Tanzilli A, Muzi L, Giovanardi G, Lingiardi V. Does reflective functioning mediate the relationship between attachment and personality? Psychiatry Res 2017. [PMID: 28645076 DOI: 10.1016/j.psychres.2017.06.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mentalization, operationalized as reflective functioning (RF), can play a crucial role in the psychological mechanisms underlying personality functioning. This study aimed to: (a) study the association between RF, personality disorders (cluster level) and functioning; (b) investigate whether RF and personality functioning are influenced by (secure vs. insecure) attachment; and (c) explore the potential mediating effect of RF on the relationship between attachment and personality functioning. The Shedler-Westen Assessment Procedure (SWAP-200) was used to assess personality disorders and levels of psychological functioning in a clinical sample (N = 88). Attachment and RF were evaluated with the Adult Attachment Interview (AAI) and Reflective Functioning Scale (RFS). Findings showed that RF had significant negative associations with cluster A and B personality disorders, and a significant positive association with psychological functioning. Moreover, levels of RF and personality functioning were influenced by attachment patterns. Finally, RF completely mediated the relationship between (secure/insecure) attachment and adaptive psychological features, and thus accounted for differences in overall personality functioning. Lack of mentalization seemed strongly associated with vulnerabilities in personality functioning, especially in patients with cluster A and B personality disorders. These findings provide support for the development of therapeutic interventions to improve patients' RF.
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Affiliation(s)
- Maria Paola Nazzaro
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy
| | - Tommaso Boldrini
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy
| | - Laura Muzi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy.
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Evidence-based assessment in a transtheoretical and paradigmatic approach. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2017. [DOI: 10.5114/cipp.2017.70141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Evidence-based practice (EBP) is a defined proposal for how to integrate science and clinical practice that treats scientific evidence, particularly the results of empirical research, as a source of clinically useful and highly objective knowledge. We assume that the principles and standards of clinical practice defined in EBP have resulted in the emergence of many trans-theoretical models, but have also significantly influenced the credibility of practice derived from paradigmatic approaches. <br />
The aim of the article is to share our reflections on two issues: 1) What clinical problems arise in non-standard situations in the application of evidence-based practice for the best clinical outcomes for a patient with mental health problems? 2) What methods of integrating patient data are used by clinical psychologists in a transtheoretical and paradigmatic approach in differential (assessment), structural-functional and epigenetic (case formulation) diagnosis? In connection with developed standards for diagnosis and the effectiveness of psychotherapy, we consider EBP particularly relevant for the theory and practice of clinical psychology.
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Abstract
Is a psychology of the “person” a science? An art? Or is it a case of a “phase 1 science”—with its own logical rules and with a continuous character of changeability? Can it be any other than this, if the concept of a psychological person is always derived from a particular and always subject to its changeability? In a suspended phase 1 science, the psychologist’s role as a person, who is a thinker, is central. The psychologist’s thinking about the concept of the person is continuously engaged. It remains open to re-focus and to changes in its relation to other concepts and to target phenomena. Changes in the psychologist’s thinking keep discovery a dynamic process; yet move psychological concepts closer to accommodating scientific goals. A logical framework, which can accommodate this discovery mode, can achieve two contrary goals: changeability versus increased accommodation of scientific goals of sharpening hypotheses.
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Lingiardi V, Giovanardi G. Challenges in assessing personality of individuals with Gender Dysphoria with the SWAP-200. J Endocrinol Invest 2017; 40:693-703. [PMID: 28238165 DOI: 10.1007/s40618-017-0629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/30/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Personality assessment can be useful to better understand the complexity of transgender and transsexual people. In particular, the Shedler Westen Assessment Procedure-200 (SWAP-200) is a measure that provides an accurate dimensional evaluation of personality. When assessing gender non-conforming people, however, clinicians can encounter some difficulties in giving appropriate ratings to all the items. PURPOSE OF THE REVIEW A brief guide to the use of SWAP-200 with transgender patients is provided, taking into account three areas of psychological functioning: identity, relationships and sexuality. The authors review, one by one, the SWAP-200 items related to these areas, and, relying on their clinical experience and on scientific literature on Gender Dysphoria, they propose recommendations for making personality diagnoses meaningful. CONCLUSION This paper facilitates a better clinical understanding of transgender people, and help clinicians to be more knowledgeable in the assessment of this heterogeneous population.
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Affiliation(s)
- V Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - G Giovanardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
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Lingiardi V, Giovanardi G, Fortunato A, Nassisi V, Speranza AM. Personality and Attachment in Transsexual Adults. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1313-1323. [PMID: 28210932 DOI: 10.1007/s10508-017-0946-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 06/06/2023]
Abstract
The main aim of this study was to investigate the associations between personality features and attachment patterns in transsexual adults. We explored mental representations of attachment, assessed personality traits, and possible personality disorders. Forty-four individuals diagnosed with gender identity disorder (now gender dysphoria), 28 male-to-female and 16 female-to-male, were evaluated using the Shedler-Westen assessment procedure-200 (SWAP-200) to assess personality traits and disorders; the adult attachment interview was used to evaluate their attachment state-of-mind. With respect to attachment, our sample differed both from normative samples because of the high percentage of disorganized states of mind (50% of the sample), and from clinical samples for the conspicuous percentage of secure states of mind (37%). Furthermore, we found that only 16% of our sample presented a personality disorder, while 50% showed a high level of functioning according to the SWAP-200 scales. In order to find latent subgroups that shared personality characteristics, we performed a Q-factor analysis. Three personality clusters then emerged: Healthy Functioning (54% of the sample); Depressive/Introverted (32%) and Histrionic/Extroverted (14%). These data indicate that in terms of personality and attachment, GD individuals are a heterogeneous sample and show articulate and diverse types with regard to these constructs.
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Affiliation(s)
- Vittorio Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 86, 00185, Rome, Italy.
| | - Guido Giovanardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 86, 00185, Rome, Italy
| | - Alexandro Fortunato
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 86, 00185, Rome, Italy
| | - Valentina Nassisi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 86, 00185, Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via dei Marsi 86, 00185, Rome, Italy
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36
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Straccamore F, Ruggi S, Lingiardi V, Zanardi R, Vecchi S, Oasi O. Personality Factors and Depressive Configurations. An Exploratory Study in an Italian Clinical Sample. Front Psychol 2017; 8:251. [PMID: 28316575 PMCID: PMC5334344 DOI: 10.3389/fpsyg.2017.00251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/08/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction: This study focuses on the relationship between personality configurations and depressive experiences. More specifically, the aim of this study is to investigate the relationship between self-criticism and dependency and personality styles or disorders, exploring the association between personality features and depressive symptoms. The two-configurations model of personality developed by Blatt (2004, 2008) is adopted as a reference point in sharing a valid framework and in understanding the results. Methods: Five instruments are administered to 51 participants with a diagnosis of depressive disorder, in accordance with DSM-IV-TR (American Psychiatric Association, 2000): Self-criticism and dependency dimensions of depression are measured with the Depressive Experiences Questionnaire (DEQ); self-reported depression is assessed with the Beck Depression Inventory-II (BDI-II); observer-rated depression is assessed with the Hamilton Depression Rating Scale (HDRS); personality is assessed with the Clinical Diagnostic Interview (CDI) and the Shedler Westen Assessment Procedure-200 (SWAP-200). Results: Only self-criticism, and not dependency, is associated with depressive symptoms. In addition, the SWAP Borderline PD Scale and the Dysphoric: Emotionally dysregulated Q-factor emerge as significant in predicting depression. Conclusions: Findings support the assumption that depressive personality configurations can enhance the vulnerability to developing depression. Theoretical and clinical implications of these results are discussed.
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Affiliation(s)
- Francesca Straccamore
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome Rome, Italy
| | - Simona Ruggi
- Department of Psychology, Università Cattolica del Sacro Cuore Milan, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome Rome, Italy
| | - Raffaella Zanardi
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University (UniSR) Milan, Italy
| | - Sara Vecchi
- Department of Psychology, Università Cattolica del Sacro Cuore Milan, Italy
| | - Osmano Oasi
- Department of Psychology, Università Cattolica del Sacro Cuore Milan, Italy
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37
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Nakash O, Nagar M. Assessment of diagnostic information and quality of working alliance with clients diagnosed with personality disorders during the mental health intake. J Ment Health 2017. [DOI: 10.1080/09638237.2017.1294740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Maayan Nagar
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
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38
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Tanzilli A, Colli A, Gualco I, Lingiardi V. Patient Personality and Relational Patterns in Psychotherapy: Factor Structure, Reliability, and Validity of the Psychotherapy Relationship Questionnaire. J Pers Assess 2017; 100:96-106. [DOI: 10.1080/00223891.2016.1272050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Antonello Colli
- Department of Humanistic Studies, University “Carlo Bo,” Urbino, Italy
| | - Ivan Gualco
- Center for Individual and Couple Therapy, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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39
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Gazzillo F, Gorman B, Bush M, Silberschatz G, Mazza C, Faccini F, Crisafulli V, Alesiani R, De Luca E. Reliability and Validity of the Interpersonal Guilt Rating Scale-15: A New Clinician-Reporting Tool for Assessing Interpersonal Guilt According to Control-Mastery Theory. Psychodyn Psychiatry 2017; 45:362-384. [PMID: 28846509 DOI: 10.1521/pdps.2017.45.3.362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article introduces the Interpersonal Guilt Rating Scale-15 (IGRS-15), a brief clinician-rated tool for the clinical assessment of interpersonal guilt as conceived in Control-Mastery Theory (CMT; Silberschatz, 2015; Weiss, 1993), and its psychometric proprieties. The items of the IGRS-15 were derived from the CMT clinical and empirical literature about guilt, and from the authors' clinical experiences. Twenty-eight clinicians assessed 154 patients with the IGRS-15, the patient self-reported Interpersonal Guilt Questionnaire-67 (IGQ-67; O'Connor, Berry, Weiss, Bush, & Sampson, 1997), and the Clinical Data Form (CDF; Westen & Shedler, 1999). A semi-exploratory factor analysis pointed to a four-factor solution in line with the kinds of guilt described in CMT: Survivor guilt, Separation/disloyalty guilt, Omnipotent responsibility guilt, and Self-hate. The test-retest reliability of the IGRS-15 was good. Moreover, the IGRS-15 showed good concurrent and discriminant validity with the IGQ-67. IGRS-15 represents a first step in the direction of supporting the clinical judgment about interpersonal guilt with an empirically sound and easy-to-use tool.
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Affiliation(s)
- Francesco Gazzillo
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Italy
| | - Bernard Gorman
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, New York
| | - Marshall Bush
- San Francisco Psychotherapy Research Group, San Francisco, CA
| | | | | | | | | | - Roberta Alesiani
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro, Scientific Institute H San Raffaele, Milan, Italy
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40
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Gritti ES, Samuel DB, Lang M. Diagnostic Agreement Between Clinicians and Clients: The Convergent and Discriminant Validity of the SWAP-200 and MCMI-III Personality Disorder Scales. J Pers Disord 2016; 30:796-812. [PMID: 26623535 DOI: 10.1521/pedi_2015_29_231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A particularly controversial aspect in the field of personality assessment is the use of self-report measures, versus clinicians' evaluations, for diagnosing personality disorder (PD). No studies have systematically documented the agreement between these sources for the entire array of DSM-5 PDs using comprehensive measures and experienced clinicians' judgments. The present work fills this gap by indexing the agreement between patients' self-descriptions and clinicians' judgments, relying on standardized and thorough PD instruments. The Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 1999b) and the Millon Clinical Multiaxial Inventory-III (Millon, Davis, & Millon, 1997) were both completed in a clinical series of 56 adult outpatients. Analyses highlighted moderate correlations between the two measures for the 10 DSM-5 PDs (Mdn = .35). Agreement was highest for psychological features that are more easily observable by the clinicians. Furthermore, results revealed problematic discriminant validity between the two instruments.
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Affiliation(s)
| | - Douglas B Samuel
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana
| | - Margherita Lang
- Department of Psychology, Milan Bicocca University, Milan, Italy.,Associazione per la Ricerca in Psicologia Clinica - A.R.P., Milan, Italy
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41
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Raglio A, Traficante D, Oasi O. A Coding Scheme for the Evaluation of the Relationship in Music Therapy Sessions. Psychol Rep 2016; 99:85-90. [PMID: 17037452 DOI: 10.2466/pr0.99.1.85-90] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study presents a coding system for observation and monitoring of changes in the interactive behaviour between patient and therapist during music therapy sessions. The coding scheme was developed from a psychodynamic framework and mainly consists of four behavioural classes: Verbal Communication, Nonverbal Communication, Countenance, and Sonorous Musical Communication. The 15 minutes in the middle of each videotape concerning the first active music therapy session—based on the sonorous musical improvisation—were coded. Subjects were children (4 boys; 3 girls) ages 3 to 10 years ( M age = 6.3), diagnosed with Pervasive Developmental Disorder, and seven therapists. The method for data collection was continuous recording, applied through The Observer Video-Pro 5.0. For the reliability indexes there was a substantial agreement between assessments by video raters.
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Affiliation(s)
- A Raglio
- Music Therapy School "Glass Harmonica", Anni Verdi Association, Rome, Italy
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42
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Westerman MA, Steen EM. Going Beyond the Internal—External Dichotomy in Clinical Psychology. THEORY & PSYCHOLOGY 2016. [DOI: 10.1177/0959354307075048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thinking in terms of a dichotomy between `internal' processes, on the one hand, and behaviors and events in the `external' world, on the other, is a pervasive, problematic feature of work in clinical psychology. Although there have been calls for rejecting this approach, it remains far from clear how to move beyond it. The authors address this issue by presenting a framework for participatory accounts. This framework is based on a philosophical perspective that takes as its starting point the person involved in practical activities. It includes five points about substantive and methodological matters. The authors illustrate the participatory approach by discussing a new conceptualization of defense processes called the theory of interpersonal defense in order to (a) show that going beyond the internal—external dichotomy can lead to fresh insights in a substantive area of inquiry, and (b) provide an example that can serve as a guide for investigators interested in approaching other issues in clinical psychology in a manner based on the participatory framework.
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Ægisdóttir S, White MJ, Spengler PM, Maugherman AS, Anderson LA, Cook RS, Nichols CN, Lampropoulos GK, Walker BS, Cohen G, Rush JD. The Meta-Analysis of Clinical Judgment Project: Fifty-Six Years of Accumulated Research on Clinical Versus Statistical Prediction. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000005285875] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical predictions made by mental health practitioners are compared with those using statistical approaches. Sixty-seven studies were identified from a comprehensive search of 56 years of research; 92 effect sizes were derived from these studies. The overall effect of clinical versus statistical prediction showed a somewhat greater accuracy for statistical methods. The most stringent sample of studies, from which 48 effect sizes were extracted, indicated a 13% increase in accuracy using statistical versus clinical methods. Several variables influenced this overall effect. Clinical and statistical prediction accuracy varied by type of prediction, the setting in which predictor data were gathered, the type of statistical formula used, and the amount of information available to the clinicians and the formulas. Recommendations are provided about when and under what conditions counseling psychologists might use statistical formulas as well as when they can rely on clinical methods. Implications for clinical judgment research and training are discussed.
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Affiliation(s)
| | | | | | | | - Linda A. Anderson
- the University Counseling and Psychological Services, Oregon State University
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Abstract
The Major Contribution in the September issue of The Counseling Psychologist provides several points to consider as the field defines the profession and training models for the 21st century. Calls for returning, in part, to our roots in career and vocational issues as well as our presence in the schools and recommendations for increased focus on children and adolescents should enable the retention of, and perhaps the increase in, our relevance in colleges of education. This reaction adds to this list a continued focus on personal adjustment and crucial attention to marriage and family issues, areas that can augment our institutional fit. Interpretations of survey data on outcomes of training models and racial-ethnic representation in our programs are offered. Little evidence exists to indicate advantages in moving counseling psychology away from its exclusive adherence to a scientist-professional training model. Our contributions to broad educational goals can positively impact our movement toward diverse and representative program faculty.
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45
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Parolin M, Simonelli A, Mapelli D, Sacco M, Cristofalo P. Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early. Front Psychol 2016; 7:887. [PMID: 27378983 PMCID: PMC4909766 DOI: 10.3389/fpsyg.2016.00887] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/30/2016] [Indexed: 12/02/2022] Open
Abstract
Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.
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Affiliation(s)
- Micol Parolin
- Department of Developmental Psychology and Socialization, University of Padova Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padova Padua, Italy
| | - Daniela Mapelli
- Department of General Psychology, University of Padova Padua, Italy
| | - Marianna Sacco
- Department of Developmental Psychology and Socialization, University of Padova Padua, Italy
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Waugh MH. Mentors, Muses, and Memories: Personal Narratives From Psychological Assessment. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2015. [DOI: 10.1080/10720537.2015.1026428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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DeFife JA, Goldberg M, Westen D. Dimensional assessment of self- and interpersonal functioning in adolescents: implications for DSM-5's general definition of personality disorder. J Pers Disord 2015; 29:248-60. [PMID: 23398103 DOI: 10.1521/pedi_2013_27_085] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Central to the proposed DSM-5 general definition of personality disorder (PD) are features of self- and interpersonal functioning. The Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) is a coding system that assesses eight dimensions of self- and relational experience that can be applied to narrative data or used by clinically experienced observers to quantify observations of patients in ongoing psychotherapy. This study aims to evaluate the relationship of SCORS-G dimensions to personality pathology in adolescents and their incremental validity for predicting multiple domains of adaptive functioning. A total of 294 randomly sampled doctoral-level clinical psychologists and psychiatrists described an adolescent patient in their care based on all available data. Individual SCORS-G variables demonstrated medium-to-large effect size differences for PD versus non-PD identified adolescents (d = .49-1.05). A summary SCORS-Composite rating was significantly related to composite measurements of global adaptive functioning (r = .66), school functioning (r = .47), externalizing behavior (r = -.49), and prior psychiatric history (r = -.31). The SCORS-Composite significantly predicted variance in domains of adaptive functioning above and beyond age and DSM-IV PD diagnosis (ΔR(2)s = .07-.32). As applied to adolescents, the SCORS-G offers a framework for a clinically meaningful and empirically sound dimensional assessment of self- and other representations and interpersonal functioning capacities. Our findings support the inclusion of self- and interpersonal capacities in the DSM-5 general definition of personality disorder as an improvement to existing PD diagnosis for capturing varied domains of adaptive functioning and psychopathology.
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Samuel DB. A review of the agreement between clinicians’ personality disorder diagnoses and those from other methods and sources. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cpsp.12088] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Silzer R, Jeanneret R. Individual Psychological Assessment: A Practice and Science in Search of Common Ground. INDUSTRIAL AND ORGANIZATIONAL PSYCHOLOGY-PERSPECTIVES ON SCIENCE AND PRACTICE 2015. [DOI: 10.1111/j.1754-9434.2011.01341.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
During the past 30 years, individual psychological assessment (IPA) has gained in use and in value to organizations in the management of human resources. However, even though IPA is considered a core competency for industrial–organizational (I–O) psychology, its practice is not without critics. This article is written not only to address several criticisms of IPA but also to discuss a variety of issues that must be taken into consideration if IPA is to advance as a major component of the I–O scientist–practitioner model. We rely upon a working definition of IPA in general but, when possible, focus on executive assessment in particular, given its high level of complexity and growing popularity. We discuss the effectiveness of assessment practice, including the ongoing statistical versus clinical prediction argument and the difficulties with establishing validity. Although we are confident that IPA has many strong research and practice underpinnings, we also propose some important research questions, training guidelines, and opportunities for assessing psychologists to improve their practices.
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