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Biberdzic M, Grenyer BFS. How Much Training Do We Need? Assessing the Validity and Interrater Reliability of the PDM-2's Psychodiagnostic Chart among Less Experienced Clinicians. J Pers Assess 2022; 105:436-444. [PMID: 35771210 DOI: 10.1080/00223891.2022.2086133] [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
The Psychodynamic Diagnostic Manual - Second Edition (PDM-2) has emerging evidence supporting its clinical utility, yet one of the main limitations remains the conjecture that considerable training and experience is required. It also remains unclear how the PDM-2 framework compares with current DSM measures of personality pathology such as the Level of Personality Functioning Scale (LPFS). The aim of the present study is to examine these issues by testing whether less clinically experienced second year doctoral psychology students are able to reliably assess patients' level of personality pathology using the PDM-2's Psychodiagnostic Chart (PDC-2), and to investigate the convergence between the PDC-2 and the LPFS. Results showed adequate inter-rater reliability for both of the main PDC-2 axes, with 52% of the variance for the overall personality organization (P-Axis) rating, and 29% of the overall M-Axis score being due to rater consensus. Reliability of individual ratings ranged from fair to excellent for the overall scores on both axes (ICC = 0.59 to .90). Results also showed that student evaluations were valid, with the latter's assessment of the patients' level of personality organization converging both with the experts' rating of the PDC-2 as well as the LPFS. Implications for clinical training are discussed.
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Affiliation(s)
- Marko Biberdzic
- School of Psychology Illawarra Health and Medical Research Institute, University of Wollongong
| | - Brin F S Grenyer
- School of Psychology Illawarra Health and Medical Research Institute, University of Wollongong
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2
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Haggerty G, Stein M, Siefert C, Zodan J, Mehra A, Ogbuji K, Sangha J, Habib M, Sinclair SJ, Blais MA. Dimensional measure of self and interpersonal functioning: Comparisons with treatment alliance and readiness for inpatient psychotherapy. Clin Psychol Psychother 2018; 25:575-582. [PMID: 29667270 DOI: 10.1002/cpp.2193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/08/2022]
Abstract
The social cognition and object relations scale-global rating method is a clinical rating system assessing 8 domains of self and interpersonal functioning. It can be applied to score numerous forms of narrative data. In this study, we investigate the SCORS-G relationship to measures of alliance and readiness for psychotherapy with an adolescent inpatient sample. Seventy-two psychiatrically hospitalized adolescents were consented and subsequently rated by their individual and group therapist using the SCORS-G. The unit psychiatrist also completed an assessment of patients' readiness for inpatient psychotherapy. The patients completed a self-report of their alliance with the inpatient treatment team as a whole. SCORS-G ratings were positively correlated with assessments of readiness for inpatient psychotherapy and patient-reported alliance. This study further demonstrates the clinical utility of the SCORS-G with adolescents.
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Affiliation(s)
- Greg Haggerty
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Michelle Stein
- Psychiatry Department, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Caleb Siefert
- Psychology, University of Michigan-Dearborn, Dearborn, MI, USA
| | - Jennifer Zodan
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Ashwin Mehra
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Kelechi Ogbuji
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Jaspreet Sangha
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Michael Habib
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | | | - Mark A Blais
- Psychiatry Department, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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3
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Lingiardi V, McWilliams N, Muzi L. The Contribution of Sidney Blatt's Two-Polarities Model to the Psychodynamic Diagnostic Manual. RESEARCH IN PSYCHOTHERAPY (MILANO) 2017; 20:242. [PMID: 32913735 PMCID: PMC7451364 DOI: 10.4081/ripppo.2017.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/23/2017] [Accepted: 02/01/2017] [Indexed: 11/23/2022]
Abstract
This article reviews the theoretical and empirical contributions of Blatt's two-polarities model of personality development and psychopathology to the second edition of the Psychodynamic Diagnostic Manual (PDM-2). First, we briefly provide an overview of the manual's main features and describe the guiding principles of the revision process. We then discuss in more detail how Blatt's model, which is focused on the dialectic interaction between anaclitic-introjective and relatedness vs self-definition dimensions in both normal and disrupted personality development, increases the PDM-2's theoretical and empirical comprehensiveness and clinical utility, especially concerning the classification and assessment of personality and overall mental functioning in adult populations. Finally, we address the implications for the therapeutic process, showing how anaclitic and introjective patients may be differentially responsive to different psychodynamic techniques (e.g., supportive or expressive interventions). Taken together, these considerations demonstrate the importance of a more theory-driven and empirically informed diagnostic system that embraces, in accordance with Sidney Blatt's empirically supported and psychoanalytically-oriented ideas, the complexities of human experience (both normal and pathological) and captures the subjective and underlying dynamics of psychological symptoms and syndromes.
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Affiliation(s)
- Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Nancy McWilliams
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Laura Muzi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Lingiardi V, McWilliams N. The psychodynamic diagnostic manual - 2nd edition (PDM-2). World Psychiatry 2015; 14:237-9. [PMID: 26043343 PMCID: PMC4471982 DOI: 10.1002/wps.20233] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Nancy McWilliams
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
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Gordon RM, Gazzillo F, Blake A, Bornstein RF, Etzi J, Lingiardi V, McWilliams N, Rothery C, Tasso AF. The Relationship between Theoretical Orientation and Countertransference Expectations: Implications for Ethical Dilemmas and Risk Management. Clin Psychol Psychother 2015; 23:236-45. [PMID: 25820633 DOI: 10.1002/cpp.1951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/26/2015] [Accepted: 02/28/2015] [Indexed: 11/06/2022]
Abstract
UNLABELLED Countertransference (CT) awareness is widely considered valuable for differential diagnosis and the proactive management of ethical dilemmas. We predicted that the more practitioners' theoretical orientation (TO) emphasizes insight into the dynamics of subjective mental life, the better they will be at using their CT expectations in differential diagnosis with high-risk patients. To test this hypothesis, we compared psychodynamic therapy (PDT) practitioners who emphasize insight into subjective mental life with practitioners who do not emphasize this epistemology. Results indicated that PDT practitioners expected significantly more CT than practitioners of cognitive-behavioural therapy (CBT) and other practitioners (e.g., family systems, humanistic/existential and eclectic) to patients with borderline personality organization overall. PDT practitioners had significantly more CT expectations to patients with borderline-level pathologies as compared with neurotic-level patients than both CBT and other practitioners. PDT practitioners were significantly more expectant of CT issues than CBT practitioners with respect to the personality disorders most associated with acting out and risk management problems (e.g., paranoid, psychopathic, narcissistic, sadistic, sadomasochistic, masochistic, hypomanic, passive-aggressive, counterdependent and counterphobic). The other practitioners generally had CT expectations between PDT and CBT. These findings suggest that clinical training into CT may be useful in differential diagnoses and in helping to avoid ethical dilemmas regardless of one's theoretical preference. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Insight into countertransference can be used to help with differential diagnoses and to help prevent possible management problems with acting out patients. The Psychodynamic Diagnostic Manual is a useful taxonomy in that it includes countertransference as a diagnostic aid.
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Affiliation(s)
| | - Francesco Gazzillo
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Blake
- Psychology, Cedar Crest College, Allentown, PA, USA
| | - Robert F Bornstein
- Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA
| | - Janet Etzi
- Department of Graduate Psychology, Immaculata University, Immaculata, PA, USA
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Nancy McWilliams
- Graduate School of Applied and Professional Psychology, Rutgers University, Flemington, NJ, USA
| | - Cheryll Rothery
- Department of Professional Psychology, Chestnut Hill College, Philadelphia, PA, USA
| | - Anthony F Tasso
- Department of Psychology and Counseling, Fairleigh Dickinson University, Madison, NJ, USA
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Bornstein RF. From Surface to Depth: Toward a More Psychodynamically Informed DSM-6. PSYCHOANALYTIC INQUIRY 2015. [DOI: 10.1080/07351690.2015.987592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Huprich SK, McWilliams N, Lingiardi V, Bornstein RF, Gazzillo F, Gordon RM. ThePsychodynamic Diagnostic Manual (PDM)and thePDM-2: Opportunities to Significantly Affect the Profession. PSYCHOANALYTIC INQUIRY 2015. [DOI: 10.1080/07351690.2015.987594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Haggerty G, Blanchard M, Baity MR, Defife JA, Stein MB, Siefert CJ, Sinclair SJ, Zodan J. Clinical validity of a dimensional assessment of self- and interpersonal functioning in adolescent inpatients. J Pers Assess 2014; 97:3-12. [PMID: 25010080 PMCID: PMC4281494 DOI: 10.1080/00223891.2014.930744] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Social Cognition and Object Relations Scale-Global Version (SCORS-G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS-G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS-G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS-G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS-G with adolescents.
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Affiliation(s)
- Greg Haggerty
- a Von Tauber Institute for Global Psychiatry , Nassau University Medical Center
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Bornstein RF, Bianucci V, Fishman DP, Biars JW. Toward a firmer foundation for DSM-5.1: domains of impairment in DSM-IV/DSM-5 personality disorders. J Pers Disord 2014; 28:212-24. [PMID: 23786269 DOI: 10.1521/pedi_2013_27_116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent editions of the Diagnostic and Statistical Manual of Mental Disorders, personality disorders (PDs) have been conceptualized as reflecting impairments in four areas: cognition, affectivity, interpersonal functioning, and impulse control. However, there have been no systematic surveys of PD symptoms to assess the degree to which these four domains of impairment are actually represented in the DSM-IV/DSM-5 PD symptom criteria. Results of such a survey indicated that the most common domain of impairment for DSM-IV/DSM-5 PDs is interpersonal functioning (41% of all PD symptoms), followed by cognition (30%), and affectivity (18%), with relatively few PD symptoms reflecting difficulties in impulse control (6%). Comparison of the proportions of symptoms in different impairment domains in DSM-III, DSM-III-R, and DSM-IV/DSM-5 confirmed that these symptom distributions have been stable across revisions of the diagnostic manual. Implications of these results for the conceptualization of PDs in DSM-5.1 and beyond are discussed.
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Bornstein RF. Combining interpersonal and intrapersonal perspectives on personality pathology: a commentary on Hopwood et al. J Pers Disord 2013; 27:296-302. [PMID: 23735038 DOI: 10.1521/pedi.2013.27.3.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Robert F Bornstein
- Derner Institute of Advanced Psychological Studies, 212 Blodgett Hall, Adelphi University, Garden City, NY 11530, USA.
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Hopwood CJ, Huprich SK. Introduction to the special issue on personality assessment in the DSM-5. J Pers Assess 2012; 93:323-4. [PMID: 22804670 DOI: 10.1080/00223891.2011.583704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The DSM-5 is poised to dramatically reshape the way clinicians and researchers assess personality by reconfiguring the conceptualization of DSM-IV personality disorders. This special issue brings together leading scholars in personality pathology, including members of the DSM-5 Personality and Personality Pathology Work Group, as well as personality assessors operating from a variety of theoretical perspectives, to describe various facets of these changes and their potential impacts and in some cases to propose alternative solutions. As we describe in this brief introductory article, the articles in this special issue highlight several important and controversial issues in the transition to DSM-5 personality assessment.
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Affiliation(s)
- Christopher J Hopwood
- Department of Psychology, Michigan State University, East Lansing, MI 48824-1116, USA.
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Tibon Czopp S. Invited commentary: applying psychodynamic developmental assessment to explore mental functioning in adolescents. J Youth Adolesc 2012; 41:1259-66. [PMID: 22407458 DOI: 10.1007/s10964-012-9749-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 02/18/2012] [Indexed: 11/26/2022]
Abstract
Recent publications in the Journal of Youth and Adolescence present a variety of topics exploring adolescents' mental functioning in the twenty first century. Conceptually, many of the articles address the intriguing, though rarely explicit, question of developmental continuities and change from adolescence to adulthood. Such investigations, which are particularly prominent in articles that discuss personality dispositions such as impulsivity or lack of empathy and their relationship to emotionally disturbed or maladaptive interpersonal behaviors, examine interactional effects of these dispositions within the personality-context matrix. From a methodological perspective, however, the major tools used for assessing personality dispositions are self-report inventories while performance-based methods, previously defined as projective tests, are not used at all despite the wide range of empirical studies that provide support for their psychometric properties. This commentary suggests that applying a theoretically based, multi-method assessment procedure in empirical research would be most fruitful for any study aimed at exploring mental functioning in adolescents. As an example, I would use the Rorschach Inkblot Method, currently being internationally considered as the most frequently applied personality test for assessing adolescents. Implications for research, practice and policy decision-making are discussed.
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Huprich SK, Meyer GJ. Introduction to the JPA special issue: Can the Psychodynamic Diagnostic Manual put the complex person back at the center-stage of personality assessment? J Pers Assess 2011; 93:109-11. [PMID: 21347960 DOI: 10.1080/00223891.2010.543203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We briefly introduce this special issue, which focuses both on the Psychodynamic Diagnostic Manual (PDM) and the practice of idiographic, depth-oriented personality assessment. The 7 articles in this issue are diverse in scope but all address these 2 important topics. To set the stage, the special issue opens with a description of the history behind, the purposes of, and the steps taken to develop the PDM, and the next article provides a compelling illustration of depth-oriented personality assessment in the context of a long-term course of psychodynamic treatment. The third and fourth articles describe how the PDM model fosters attention to dynamic processes, not just overt symptoms, and they articulate the challenges and benefits of integrating this model into both the revitalized practice of assessment and diagnosis and the research avenues that will evaluate its validity and utility. The fifth article provides a broad overview of interesting experimental research on implicit processes from personality, social, and cognitive psychology, with implications for understanding and assessing dynamic processes. The sixth article illustrates how a PDM-based assessment of an adolescent boy helpfully contributed to his psychodynamic therapy. Finally, the issue closes with an illuminating article describing a PDM-based training model for the graduated development of assessment and diagnosis skills in a doctoral program. Overall, this special issue helps show how the PDM can invigorate multimethod personality assessment by placing the complex idiographic understanding of a person at the center-stage in the assessment process.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology, Eastern Michigan University, Ypsilanti, 48197, USA.
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