Evaluating Stable and Situational Expressions of Passive-Aggressive Personality Disorder: A Multimethod Experience Sampling Case Study

The Impact of Different Thematic Apperception Test Administration Methods on Narrative Length and Story Richness as Measured by the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G)

The Thematic Apperception Test (TAT) is the second most commonly used performance-based task in clinical practice. However, traditional TAT administration is time-consuming and raises accessibility issues. This study examines the effect of administration modifications (i.e., examiner handwriting versus typing, examiner recording versus participant recording, and re-prompting versus no re-prompting) on narrative length and richness as measured by the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G). A four-card TAT protocol was administered to 150 college students under one of five conditions. The resulting narratives were scored by two trained raters using the SCORS-G. MANOVA procedures showed (a) no significant differences between examiner handwriting versus typing; (b) the shortest, blandest narratives were produced when the examiner recorded the narratives without re-prompting; and (c) the longest, richest narratives were produced when the participant typed the narratives with re-prompts on the computer screen. Clinical and research implications and future directions will be discussed.

Evaluating Change in Transference, Interpersonal Functioning, and Trust Processes in the Treatment of Borderline Personality Disorder: A Single-Case Study Using Ecological Momentary Assessment

Transference-focused psychotherapy (TFP) is an empirically supported treatment for borderline personality disorder (BPD) that improves functioning via targeting representations of self affectively relating to others, particularly as evoked in the therapeutic relationship. If change in TFP operates as theorized, then shifts in patterns of "self affectively relating to others" should be observed in the transference prior to shifts in daily relationships. Using ecological momentary assessment (EMA), a patient with BPD rated daily interpersonal events for 2-week periods during 18 months of TFP; at 9 and 18 months these ratings included interactions with the therapist. Results suggest that positive perceptions of her therapist that ran counter to her negatively biased perception in other relationships preceded changes in her perceptions of others. EMA shifts corresponded to improvements in self-reported symptoms, interview-based personality functioning, and therapist assessments. Implications for assimilation of a trusting experience with the therapist as a mechanism of change in TFP are discussed.

Longitudinal stability of Social Cognition and Object Relations Scale-Global Rating Method dimensional ratings, score ranges and narrative 'blandness' in a clinical sample

While understanding how internalized representations of others (i.e., object relations) change over the course of treatment is essential for treatment planning and evaluation of progress, few studies have examined the nature of these changes through repeated psychological assessments. In this study, we applied the SCORS-G to Thematic Apperception Test narratives for 61 adult patients with complex psychiatric problems undergoing residential treatment over an 18-month period. Over the course of treatment, patient representations of self and others became more complex, indicating improvements in mentalization. Further, an analysis of default ratings (i.e., an aspect of story 'blandness') suggested that certain shifts in SCORS-G dimensional scores over time were accounted for by greater degree of scorable content across time points, rather than changes specific to the dimensions themselves. Findings from novel exploratory analyses aimed at evaluating the test-retest reliability of both default rating proportion and several emerging alternative scoring approaches (including changes in minimum, maximum and range of scores on individual dimensions) are reported. While the magnitude of change across mean dimensional scores was found to be lower compared to those previously found in outpatient populations, our results suggest that the SCORS-G remains capable of detecting changes in mentalization capacities in individuals contending with longstanding, severe psychiatric impairment and personality-based psychopathology. Implications for treatment, assessment and future research are discussed.

An Initial Study of Practicing Psychologists' Views of the Utility of Ecological Momentary Assessment for Difficult Psychotherapy Cases

Ecological momentary assessment (EMA) is a burgeoning area of research, and several clinical applications of the resulting data have been identified by researchers, suggesting potential benefit to psychotherapy practice. However, practitioners often do not use traditional empirically-supported tools for diagnosis and outcome monitoring (e.g., validated interview measures and questionnaires). Thus, it is not clear how readily practitioners will take up newer technology-enhanced assessment methods, despite current enthusiasm among researchers. The current study aimed to explore the perceived usefulness of EMA-based tools for clinical assessment and outcome monitoring of difficult psychotherapy cases, as well as to identify correlates of attitudes about the usefulness of these tools. Clinical psychologists in active therapy practice with adults (n = 375) completed an internet survey including the Attitudes toward Standardized Assessment scale and the Attitudes toward Standardized Assessment Scales-Monitoring and Feedback. Respondents characterized their current diagnostic and outcome monitoring practices and rated how helpful they would find several assessment and outcome monitoring resources for a difficult case, including both traditional instruments and EMA-based methods. EMA-based tools had lower perceived usefulness than existing instruments. Attitudes toward standardized assessment and outcome monitoring predicted the perceived utility of these methods, as did several professional variables. Practicing psychologists may not adopt EMA for clinical assessment more readily than traditional assessment tools. Recommendations for facilitating the uptake of new technologies by psychotherapists are offered.