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Cersosimo BH, Hilsenroth MJ, Bornstein RF, Gold JR, Blais MA. Convergence in patient and therapist alliance ratings early in treatment with Personality Assessment Inventory clinical scales and subscales. Clin Psychol Psychother 2023; 30:1512-1519. [PMID: 37544895 DOI: 10.1002/cpp.2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
We examined discrepancies in 81 patient-therapist dyads' alliance ratings early in treatment (3rd or 4th session) in relation to Personality Assessment Inventory clinical scales, subscales and global psychopathology. Results indicated that PAI global psychopathology (mean clinical elevation) and the scales of Aggression [AGG], Somatization [SOM], and Anxiety-Related Disorders [ARD] were significantly, negatively associated with an absolute difference of patient and therapist alliance ratings at Session 3. Higher initial scores on these clinical scales at treatment onset are associated with less difference (i.e., more convergence) in patient/ therapist ratings of alliance at Session 3. Correlations between PAI clinical subscales and absolute differences of patient and therapist alliance ratings at Session 3 also demonstrated statistically significant inverse relationships for several PAI subscales of Aggression- Attitude [AGG-A], Aggression-Physical [AGG-P], Somatic- Health Concerns [SOM-H], Anxiety-Related Disorders-Traumatic Stress [ARD-T], Anxiety-Related Disorders- Obsessive Compulsive [ARD-O], Borderline Features-Affective Instability [BOR-A], Borderline- Self-Harm [BOR-S], Anxiety-Physiological [ANX-P], Depression-Physiological [DEP-P] and Antisocial-Stimulus Seeking [ANT-S]. Again, higher scores on these subscales at treatment onset are associated with less difference (i.e., more convergence) in patient/therapist ratings. We also examined group differences between patients rating alliance higher (Group 1) and therapists rating alliance higher (Group 2) and found that Group 1 had significantly lower scores on Mania-Activity Level [MAN-A]. Clinical implications of results are discussed.
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Affiliation(s)
- Bianca H Cersosimo
- Derner School of Psychology, Adelphi University, Garden City, New York, United States
| | - Mark J Hilsenroth
- Derner School of Psychology, Adelphi University, Garden City, New York, United States
| | - Robert F Bornstein
- Derner School of Psychology, Adelphi University, Garden City, New York, United States
| | - Jerold R Gold
- Derner School of Psychology, Adelphi University, Garden City, New York, United States
| | - Mark A Blais
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Levy SR, Hilsenroth MJ, Conway F, Owen J. Patient personality characteristics and therapeutic integration: treating borderline personality and emotionally dysregulated-dysphoric personality features. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35796595 PMCID: PMC9422319 DOI: 10.4081/ripppo.2022.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022]
Abstract
This study examines the relationship between patient personality characteristics and therapeutic integration. Within a sample of patients (N=93) receiving outpatient psychodynamically- oriented psychotherapy, we assessed patient Borderline and Emotionally Dysregulated personality features through the Shedler-Westen Assessment Procedure (SWAP-200), and therapeutic technique using the Comparative Psychotherapy Process Scale (CPPS) during an early treatment session. We examined personality dimensionally, psychotherapy interventions across different theoretical orientations, as well as psychotherapy integration. These analyses revealed an overlap between the Borderline Clinical Prototype and the Emotionally Dysregulated-Dysphoric Q-factor, with the former associated with higher use of integration and the latter associated with higher use of either psychodynamicinterpersonal or cognitive-behavioural interventions. Secondary analyses also indicated the greater presence of interventions oriented towards emotional exploration and to the didactic instruction of effective symptom coping techniques across both of these personality subtypes early in treatment. The key differences between these personality types, as well as the theoretical, empirical, and clinical implications of these findings are discussed.
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Cersosimo BH, Hilsenroth MJ, Bornstein RF, Gold JR, Blais MA. Personality assessment inventory items in relation to patient- and therapist-rated alliance. Clin Psychol Psychother 2022; 29:1905-1917. [PMID: 35701013 DOI: 10.1002/cpp.2759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/06/2022]
Abstract
Based on the results of prior research, we examined relationships between Personality Assessment Inventory (PAI) items on clinical scales of antisocial features (ANT) and anxiety-related disorders (ARD) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also explored the relationship between the PAI treatment rejection scale (RXR) and early session therapist-rated alliance, despite null findings in previous work. We used PAI protocols from a clinical outpatient sample (N = 80). Data were analysed using backwards linear regressions. Results indicated that a group of ANT items from different ANT subscales predicted patient-rated therapeutic alliance, F(8,59) = 5.182, p = .000, R2 of .413, f2 = 0.70. Additionally, a group of ARD items from different ARD subscales significantly predicted therapist-rated alliance, F(6,62) = 3.007, p = .012, R2 of .225, f2 = 0.29. No significant relationships were found for RXR items and therapist-rated alliance, consistent with prior findings. Clinical implications are discussed.
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Affiliation(s)
- Bianca H Cersosimo
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Mark J Hilsenroth
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Robert F Bornstein
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Jerold R Gold
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Mark A Blais
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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McMillen K, Hilsenroth M, Moore M, Gold J. Interpersonal clusters in a depressed outpatient sample. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cersosimo BH, Hilsenroth MJ, Bornstein RF, Gold JR. Personality Assessment Inventory Clinical Scales in Relation to Patient and Therapist Rated Alliance Early in Treatment. Assessment 2021; 29:806-816. [PMID: 33559486 DOI: 10.1177/1073191121990092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined relationships between the Personality Assessment Inventory (PAI) clinical scales (e.g., Somatic Complaints [SOM]) and subscales (e.g., Conversion [SOM-C]) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also replicated and extended findings from a previous study examining PAI treatment scales (Treatment Rejection, Treatment Process Index) and early session therapist-rated alliance. We used PAI protocols from a clinical outpatient sample (N = 84). Data were analyzed using stepwise linear regressions. Results suggest that patients who report lower early session alliance also report more antisocial features (β = -.219, p = .050, f2 = 0.05) specifically more antisocial behaviors (β = -.315, p = .004, f2 = 0.11). Additionally, therapists report higher early session alliance with patients who report more anxiety-related disorders (β = .274, p = .012, f2 = 0.08), specifically traumatic stress (β = .325, p = .003, f2 = 0.12). No significant relationships were found between patient- or therapist-rated alliance and Treatment Rejection and Treatment Process Index, consistent with prior findings. Clinical implications are discussed.
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Affiliation(s)
- Bianca H Cersosimo
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA
| | - Mark J Hilsenroth
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA
| | - Robert F Bornstein
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA
| | - Jerold R Gold
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA
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Jonas JB, Wei WB, Xu L, Rietschel M, Streit F, Wang YX. Self-rated depression and eye diseases: The Beijing Eye Study. PLoS One 2018; 13:e0202132. [PMID: 30096194 PMCID: PMC6086446 DOI: 10.1371/journal.pone.0202132] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022] Open
Abstract
Purpose To assess the prevalence of depression in the general population of Beijing and its association with ocular diseases. Methods The population-based Beijing Eye Study was conducted in a rural and an urban region of Greater Beijing. The study participants underwent a detailed ophthalmological examination and an interview including questions on the socioeconomic background. Depressive symptoms were evaluated using a Chinese depression scale adapted from Zung´s self-rated depression scale. The total score of depression symptoms was 80. Depression was defined as having a depression score >44. Results Out of 3468 study participants, 3267 (94.2%) individuals (1419 men) with an age of 64.5±9.7 years (range: 50–93 years) participated in the interview and answered all questions on depression. The mean depression score was 25.0±5.9 (median: 23.3; range:20–64). Depression (depression score >44) was present in 66 individuals (2.0%; 95% confidence interval (CI): 1.5, 2.5), and 5 individuals (0.2%; 95%CI: 0.02,0.3) had a depression score ≥59. In multivariate regression, analysis, a higher depression score was associated (regression coefficient r2: 0.22) with a higher number of days with dry eye feeling (P<0.001; standardized regression coefficient beta: 0.09; non-standardized regression coefficient B: 0.20; 95%CI: 0.12,0.29) and shorter corneal curvature radius (P = 0.03;beta:-0.04; B:1.01; 95%CI: -1.90,-0.12), after adjusting for age, gender, region of habitation, body mass index, cognitive function score, life quality score and blood concentration of triglycerides. Adding age-related macular degeneration (P = 0.10), glaucoma (P = 0.77), diabetic retinopathy (P = 0.77), nuclear cataract (P = 0.35), cortical cataract (P = 0.58) or posterior subcapsular cataract (P = 0.28) as single parameters to the model revealed no significant correlation with the depression score. Lower best corrected visual acuity showed a marginal significant association (P = 0.05; beta: 0.04; B: 1.56; 95%CI: -0.01, 3.13). Conclusions Dry eye feeling was the only common ocular disorder associated with an increased depression score, while the occurrence of age-related macular degeneration, any type of glaucoma, diabetic retinopathy, any type of cataract and keratoconus were not significantly associated with an increased depression score. Lower visual acuity was marginally associated. The prevalence of depression in the population aged 50+ years in Greater Beijing was 2.0% (96%CI: 1.5, 2.5).
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Affiliation(s)
- Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Mannheim, Germany
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
- * E-mail:
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Expert and self-assessment of lifetime symptoms and diagnosis of major depressive disorder in large-scale genetic studies in the general population: comparison of a clinical interview and a self-administered checklist. Psychiatr Genet 2018; 27:187-196. [PMID: 28731911 PMCID: PMC5576521 DOI: 10.1097/ypg.0000000000000182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Supplemental Digital Content is available in the text. Major depression disorder (MDD) is a complex neuropsychiatric disorder and an increasing number of genetic risk variants are being identified. Investigation of their influence in the general population requires accurate and efficient assessment of depressive symptoms. Here, clinical interviews conducted by clinicians are the gold standard. We investigated whether valid and reliable clinical phenotypes can be obtained efficiently using self-administered instruments. Lifetime depressive symptoms and lifetime MDD diagnosis were assessed in 464 population-based individuals using a clinical interview and a structured, self-administered checklist. Analyses were carried out of the following: (i) intraclass correlations (ICC) between checklist and interview; (ii) sensitivity/specificity of the checklist; and (iii) the association of interview and checklist with a positive family history of MDD (FH-MDD+). The correspondence of the self-administered checklist with the clinical interview was good for most depressive symptoms (ICC=0.60–0.80) and moderate for MDD diagnosis (ICC=0.45). With the consecutive inclusion of MDD diagnostic criteria, sensitivity decreased from 0.67 to 0.46, whereas specificity remained high (0.95). For checklist and interview, strong associations were found between FH-MDD+ and most depressive symptoms and MDD diagnosis (all odds ratio≥1.83). The self-administered checklist showed high reliability for both the assessment of lifetime depressive symptoms and screening for individuals with no lifetime diagnosis of MDD. However, attention is warranted when the aim is to identify MDD cases. The positive association between depressive symptomatology and FH-MDD+ indicates the usefulness of both instruments to assess patients in genetic studies. Our data suggest that the more time-efficient and cost-efficient self-administered instruments also allow for the assessment of depressive symptoms accurate enough to investigate the influence of MDD genetic risk variants in the general population.
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Jeon YW, Han SI, Park EJ. The relation between immunologic variables and symptom factors in patients with major depressive disorder. Ann Gen Psychiatry 2018; 17:32. [PMID: 30065772 PMCID: PMC6062952 DOI: 10.1186/s12991-018-0201-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/10/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The associations between depression and immunity were investigated by measuring the scores of Hamilton Rating Scale for Depression (HRSD) and peripheral lymphocyte parameters in patients with major depressive disorder (MDD). METHODS Forty-nine patients with MDD were recruited and their clinical symptoms are evaluated with 17-item HRSD which was factorized using the confirmatory factor analysis (i.e., depression factor, insomnia factor, and anxiety factor). Basic immunologic variables such as CD4, CD8, and CD56-positive cell numbers were measured by flow cytometry. Natural killer cell activity (NKCA) was also assessed by ELISA method using K-562 cells as target cells. All patients were treated for 4 weeks with selective serotonin reuptake inhibitors. Immunologic and clinical variables were measured both at baseline and after medication. RESULTS CD8-positive cell number was increased (p < .05) and CD4/CD8 ratio was decreased (p < .01) after medication. NKCA showed a significant positive correlation with anxiety factor scores of HRSD (p < .05) at baseline. However, except NKCA, there was no correlation between other immunologic measures and symptom factors. CONCLUSION These results suggest that immunologic measure such as NKCA may be an important variable for symptom of MDD such as anxiety during acute depressive state.
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Affiliation(s)
- Yang-Whan Jeon
- Department of Psychiatry, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon, 21431 South Korea
| | - Sang-Ick Han
- Department of Psychiatry, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon, 21431 South Korea
| | - E Jin Park
- Department of Psychiatry, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon, 21431 South Korea
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Slavin-Mulford J, Clements A, Hilsenroth M, Charnas J, Zodan J. An examination of generalized anxiety disorder and dysthymia utilizing the Rorschach inkblot method. Psychiatry Res 2016; 240:137-143. [PMID: 27107389 DOI: 10.1016/j.psychres.2016.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 12/15/2015] [Accepted: 04/08/2016] [Indexed: 11/16/2022]
Abstract
This study examined transdiagnostic features of generalized anxiety disorder (GAD) and dysthymia in an outpatient clinical sample. Fifteen patients who met DSM-IV criteria for GAD and twenty-one patients who met DSM-IV criteria for dysthymia but who did not have comorbid anxiety disorder were evaluated utilizing the Rorschach. Salient clinical variables were then compared. Results showed that patients with GAD scored significantly higher on variables related to cognitive agitation and a desire/need for external soothing. In addition, there was a trend for patients with GAD to produce higher scores on a measure of ruminative focus on negative aspects of the self. Thus, not surprisingly, GAD patients' experienced more distress than the dysthymic patients. The implications of these findings are discussed with regards to better understanding the shared and distinct features of GAD and dysthymia.
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Affiliation(s)
- Jenelle Slavin-Mulford
- Department of Psychological Sciences, Augusta University, 2500 Walton Way, Augusta, GA 30904, USA.
| | - Alyssa Clements
- Department of Psychological Sciences, Augusta University, 2500 Walton Way, Augusta, GA 30904, USA
| | - Mark Hilsenroth
- Department of Clinical Psychology, Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, USA
| | - Jocelyn Charnas
- Department of Clinical Psychology, Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, USA
| | - Jennifer Zodan
- Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
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A review of peripheral biomarkers in major depression: the potential of inflammatory and oxidative stress biomarkers. Prog Neuropsychopharmacol Biol Psychiatry 2014; 48:102-11. [PMID: 24104186 DOI: 10.1016/j.pnpbp.2013.09.017] [Citation(s) in RCA: 241] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/11/2013] [Accepted: 09/26/2013] [Indexed: 11/21/2022]
Abstract
Biomarkers are regularly used in medicine to provide objective indicators of normal biological processes, pathogenic processes or pharmacological responses to therapeutic interventions, and have proved invaluable in expanding our understanding and treatment of medical diseases. In the field of psychiatry, assessment and treatment has, however, primarily relied on patient interviews and questionnaires for diagnostic and treatment purposes. Biomarkers in psychiatry present a promising addition to advance the diagnosis, treatment and prevention of psychiatric diseases. This review provides a summary on the potential of peripheral biomarkers in major depression with a specific emphasis on those related to inflammatory/immune and oxidative stress/antioxidant defences. The complexities associated with biomarker assessment are reviewed specifically around their collection, analysis and interpretation. Focus is placed on the potential of peripheral biomarkers to aid diagnosis, predict treatment response, enhance treatment-matching, and prevent the onset or relapse of major depression.
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Hilsenroth MJ, Defife JA, Blake MM, Cromer TD. The effects of borderline pathology on short-term psychodynamic psychotherapy for depression. Psychother Res 2007. [DOI: 10.1080/10503300600786748] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Wamboldt MZ, Reiss D. Genetic strategies for clarifying a nosology of relational distress. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2006; 20:378-85. [PMID: 16937994 DOI: 10.1037/0893-3200.20.3.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) has made many strides but can be improved with the addition of relationship descriptions. Relational patterns may result from individual genetic risk factors and thus help to define disorders more clearly. Relationships may also mediate genetic risk factors and be useful in identifying the genetic vulnerability, or they may moderate underlying vulnerable genes so that they are less expressed. Key prototypic relationship patterns have inherent interest to humans, moderate numerous illnesses, and deserve attention in and of themselves. Similar to the use of genetic strategies in clarifying taxons of individual disorders, genetic strategies can help delineate patterns within these key relationships, their common origins, their common outcomes, and their distinctions from near-neighbor patterns.
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Affiliation(s)
- Marianne Z Wamboldt
- Department of Psychiatry, University of Colorado at Denver, and Health Sciences Center, The Children's Hospital, Denver, CO 80218-1088, USA.
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Hilsenroth MJ, Defife JA, Blagys MD, Ackerman SJ. Effects of training in short-term psychodynamic psychotherapy: changes in graduate clinician technique. Psychother Res 2006. [DOI: 10.1080/10503300500264887] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Siefert CJ, Hilsenroth MJ, Weinberger J, Blagys MD, Ackerman SJ. The relationship of patient defensive functioning and alliance with therapist technique during short-term psychodynamic psychotherapy. Clin Psychol Psychother 2006. [DOI: 10.1002/cpp.469] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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