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Coleman SG, Ravula HP, Stein MB, Coleman JJ, Wilcox MM, Slavin-Mulford JM. 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). J Pers Assess 2024; 106:469-481. [PMID: 38078648 DOI: 10.1080/00223891.2023.2286459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/13/2023] [Indexed: 06/13/2024]
Abstract
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.
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Affiliation(s)
- Savanna G Coleman
- Department of Psychological Sciences, Augusta University, Augusta, GA, USA
| | - Havilah P Ravula
- Department of Psychological Sciences, Augusta University, Augusta, GA, USA
| | - Michelle B Stein
- Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeremy J Coleman
- Department of Psychological Sciences, Augusta University, Augusta, GA, USA
| | - Melanie M Wilcox
- Department of Psychological Sciences, Augusta University, Augusta, GA, USA
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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [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] [Indexed: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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3
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Abstract
IMPORTANCE Borderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US. The disorder is associated with considerable social and vocational impairments and greater use of medical services. OBSERVATIONS Borderline personality disorder is characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as by impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms (eg, experience of unreality of one's self or surroundings). Borderline personality disorder is typically diagnosed by a mental health specialist using semistructured interviews. Most people with BPD have coexisting mental disorders such as mood disorders (ie, major depression or bipolar disorder) (83%), anxiety disorders (85%), or substance use disorders (78%). The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse. Psychotherapy is the treatment of choice for BPD. Psychotherapy such as dialectical behavior therapy and psychodynamic therapy reduce symptom severity more than usual care, with medium effect sizes (standardized mean difference) between -0.60 and -0.65. There is no evidence that any psychoactive medication consistently improves core symptoms of BPD. For discrete and severe comorbid mental disorders, eg, major depression, pharmacotherapy such as the selective serotonin reuptake inhibitors escitalopram, sertraline, or fluoxetine may be prescribed. For short-term treatment of acute crisis in BPD, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others, crisis management is required, which may include prescription of low-potency antipsychotics (eg, quetiapine) or off-label use of sedative antihistamines (eg, promethazine). These drugs are preferred over benzodiazepines such as diazepam or lorazepam. CONCLUSIONS AND RELEVANCE Borderline personality disorder affects approximately 0.7% to 2.7% of adults and is associated with functional impairment and greater use of medical services. Psychotherapy with dialectical behavior therapy and psychodynamic therapy are first-line therapies for BPD, while psychoactive medications do not improve the primary symptoms of BPD.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Weill Cornell Medical College, Personality Disorders Institute, New York, New York
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Slavin-Mulford JM, Amerson LR, Cain LA, Hilsenroth MJ, Wilcox MM, Stein MB. How narrative source impacts convergence of ratings from the Social Cognition and Object Relations Scale-Global Rating Method with psychotherapy process measures. Clin Psychol Psychother 2021; 28:1550-1561. [PMID: 33837983 DOI: 10.1002/cpp.2595] [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] [Received: 12/16/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/08/2022]
Abstract
This study examines the construct validity of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G; Westen, 1995; see also Stein & Mulford, 2018) by exploring the degree of convergence across different narrative sources (i.e., early memories [EM] and psychotherapy narratives [PT]) in relation to patient- and therapist-rated psychotherapy process measures. Using a university-based outpatient sample (n = 81), we found limited convergence for SCORS-G ratings across narrative type. First, paired t tests showed that the means for six of the eight SCORS-G dimensions differed significantly between the EM and PT narratives with the majority having a large magnitude of effect. Moreover, despite 29 significant correlations between a SCORS-G dimension and either an alliance or session quality variable, only two of the eight SCORS-G dimensions significantly correlated with the same process variable across narrative type (e.g., patient-rated session depth with SCORS-G Self Esteem [SE] and Identity and Coherence of Self [ICS]). Importantly, the high degree of theoretical coherence in the associations that emerged between the SCORS-G dimensions and the process variables suggest that the lack of convergence was not due to limited validity of the SCORS-G. Instead, the results underscore the importance of multi-method assessment techniques by highlighting that the manner in which a narrative is elicited will impact the object relational content patients provide. Future research and clinical implications related to the SCORS-G, alliance and psychotherapy process are discussed.
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Affiliation(s)
| | - Luke R Amerson
- Department of Psychological Sciences, Augusta University, Augusta, Georgia, USA
| | - Lylli A Cain
- 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
| | - Melanie M Wilcox
- Department of Psychological Sciences, Augusta University, Augusta, Georgia, USA
| | - Michelle B Stein
- Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Emotion regulation in adolescents: Influences of internal representations of relationships - An ERP study. Int J Psychophysiol 2020; 160:1-9. [PMID: 33278467 DOI: 10.1016/j.ijpsycho.2020.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/10/2023]
Abstract
Emotion regulation (ER) strategies can decrease the intensity or modify the experience of emotions. Deficits in emotion regulation are implicated in a wide range of psychopathologies. It is argued that interpersonal, socio-cognitive, and developmental variables play an important role in ER. This is the first study to explore the contribution of individual differences in internal representations of relationships (IRR) to neural correlates of ER in a sample of adolescents. Event related potentials of 53 adolescents (12 to 17 years old) were collected while performing an ER task. IRR was assessed with the social cognition and object relations scale (SCORS-G; Westen, 1995) coding of narratives from interviews. Results show that individual differences in IRR significantly predicted the modulation of emotional responses by expressive suppression in adolescents, accounting for 48% of the variance of changes in occipital late positive potentials (LPP). Thus, it appears that IRR are implicated in an individual's ability to regulate emotions. The clinical implications of the findings are discussed.
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Haggerty G, Esang M, Salaheldin K, Lima A. The relationship between prototype ratings of personality and self and interpersonal functioning with an adolescent inpatient sample. Clin Psychol Psychother 2020; 28:364-372. [PMID: 32881158 DOI: 10.1002/cpp.2512] [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: 06/27/2019] [Revised: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022]
Abstract
Personality pathology is conceptualized, in part, as impairments in self and interpersonal functioning. Although most of the research has focused on adult samples, fewer have looked at this relationship in adolescent samples. This paper investigates the relationship between clinician-rated personality prototypes, the Shedler-Westen Assessment Procedure-Prototype Matching Adolescent Version (SWAP-A-P) derived from the SWAP-II-A, and a measure of self and interpersonal functioning, the Social Cognition and Object Relation Scale-Global Rating (SCORS-G). Clinicians rated 66 adolescents hospitalized at a safety net teaching hospital in the northeast. The patient's individual and group therapist rated the patients at discharge using the SWAP-A-P and the SCORS-G at discharge blind to each other's ratings. Results showed that more severe personality pathology was linked with more impairments in self and interpersonal functioning.
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Affiliation(s)
- Greg Haggerty
- Graduate Medical Education, Mather Hospital/Northwell Health, Port Jefferson, New York, USA
| | - Michael Esang
- Department of Behavioral Sciences, Nassau University Medical Center, East Meadow, New York, USA
| | - Khalid Salaheldin
- Graduate Medical Education, Mather Hospital/Northwell Health, Port Jefferson, New York, USA.,Department of Psychiatry, Mather Hospital Northwell Health
| | - Ateaya Lima
- Graduate Medical Education, Mather Hospital/Northwell Health, Port Jefferson, New York, USA.,Department of Psychiatry, Mather Hospital Northwell Health
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Cain L, Hilsenroth M. Examining the relationship between object relations and interpersonal distress in a clinical sample. Clin Psychol Psychother 2020; 27:760-769. [DOI: 10.1002/cpp.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Lylli Cain
- Derner School of Psychology Adelphi University Garden City New York USA
| | - Mark Hilsenroth
- Derner School of Psychology Adelphi University Garden City New York USA
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8
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Stulp HP, Glas GG, Eurelings-Bontekoe L. Validation of an implicit instrument to assess God representations. Part 2: Associations between implicit and explicit measures of God representations and object-relational functioning. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2019. [DOI: 10.1080/19349637.2019.1569490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Henk P. Stulp
- Lectorate Health Care and Spirituality, Viaa University of Applied Sciences, Zwolle, The Netherlands
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9
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Lewis KC, Ridenour JM. The Integration of EMA and Single-Occasion Multimethod Assessment Data for a Complex Psychiatric Patient. Assessment 2019; 27:1532-1546. [PMID: 30678485 DOI: 10.1177/1073191118825313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The utilization of multimethod assessment approaches can provide comprehensive information regarding daily interpersonal and personality functioning, increasing opportunities to guide treatment planning in a more personalized, evidence-based manner. The routine implementation of multimethod assessment within clinical settings, however, remains rare, and there are few studies that have reviewed the clinical utility of multimethod assessment. Our goal in this study was to analyze multimethod data collected from a single research subject enrolled in residential treatment in order to illustrate the process of integrating data across both single-occasion (e.g., self-report, performance-based, and behavioral tests) and multitimepoint (ecological momentary assessment of interpersonal experiences) dimensions. Results revealed both areas of convergence and divergence across measures, enabling the development of a complex clinical formulation that sharpened diagnostic considerations and contributed valuable insights to treatment planning. Our findings provide support for the value of incorporating multimethod assessment into routine clinical practice.
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10
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Stulp HP, Koelen J, Glas GG, Eurelings-Bontekoe L. Construction and validation of an implicit instrument to assess God representations. Part 1: Associations between implicit and explicit God representation and distress measures. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2018. [DOI: 10.1080/19349637.2018.1489750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Henk P. Stulp
- Lectorate Health Care and Spirituality, Viaa University Zwolle, Zwolle, The Netherlands
| | - Jurrijn Koelen
- GGZ Centraal De Meregaard (Outpatient Clinic for Personality Disorders), Almere, The Netherlands
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11
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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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Stein MB, Siefert CJ. Introduction to the Special Section on the Social Cognition and Object Relations Scale–Global Rating Method: From Research to Practice. J Pers Assess 2018; 100:117-121. [DOI: 10.1080/00223891.2017.1418749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michelle B. Stein
- Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School
| | - Caleb J. Siefert
- Department of Behavioral Sciences, University of Michigan-Dearborn
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Siefert CJ, Stein M, Slavin-Mulford J, Haggerty G, Sinclair SJ, Funke D, Blais MA. Exploring the Factor Structure of the Social Cognition and Object Relations-Global Rating Method: Support for Two- and Three-Factor Models. J Pers Assess 2017. [PMID: 28644680 DOI: 10.1080/00223891.2017.1336716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Social Cognition and Object Relations Scales-Global Rating Method (SCORS-G) contains 8 scales for coding narrative content. This study explores the factor structure of this measure using college (n = 171), outpatient (n = 239), and inpatient (n = 78) samples. Participants told stories to the Thematic Apperception Test (TAT; Murray, 1943) cards. Stories were transcribed and coded by blind raters using the SCORS-G. Cases were randomly assigned to an exploratory or validation group. Exploratory factor analysis with the exploratory group suggested 2- and 3-factor models. The Emotional Investment in Relationships (EIR) scale did not obtain a primary loading on any factor and was not included in subsequentmodels. After modifications, confirmatory factor analysis indicated good-to-adequate fit for 2- and 3-factor models. Both models showed good fit in the validation group and met criteria for invariance across models. Findings indicated that some SCORS-G scales tap cognitive-structural elements, whereas others assess affective-relational components of narratives. We found mild support separating the affective-relational scales in terms of internal representations for the self and others and relationships. The results reported here indicate that clinicians and researchers can calculate a separate cognitive-structural composite score and an affective-relational composite score when using the SCORS-G to rate TAT stories.
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Affiliation(s)
- Caleb J Siefert
- a Department of Behavioral Sciences , University of Michigan-Dearborn
| | - Michelle Stein
- b Psychological Evaluation and Research Laboratory (PEaRL) , Massachusetts General Hospital and Harvard Medical School
| | | | - Greg Haggerty
- d Van Tauber Institute for Global Psychiatry , Nassau University Medical Center
| | - Samuel J Sinclair
- b Psychological Evaluation and Research Laboratory (PEaRL) , Massachusetts General Hospital and Harvard Medical School
| | - Danielle Funke
- a Department of Behavioral Sciences , University of Michigan-Dearborn
| | - Mark A Blais
- b Psychological Evaluation and Research Laboratory (PEaRL) , Massachusetts General Hospital and Harvard Medical School
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Lilienfeld SO, Wood JM, Garb HN. The Scientific Status of Projective Techniques. Psychol Sci Public Interest 2017; 1:27-66. [DOI: 10.1111/1529-1006.002] [Citation(s) in RCA: 459] [Impact Index Per Article: 65.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although projective techniques continue to be widely used in clinical and forensic settings, their scientific status remains highly controversial. In this monograph, we review the current state of the literature concerning the psychometric properties (norms, reliability, validity, incremental validity, treatment utility) of three major projective instruments: Rorschach Inkblot Test, Thematic Apperception Test (TAT), and human figure drawings. We conclude that there is empirical support for the validity of a small number of indexes derived from the Rorschach and TAT. However, the substantial majority of Rorschach and TAT indexes are not empirically supported. The validity evidence for human figure drawings is even more limited. With a few exceptions, projective indexes have not consistently demonstrated incremental validity above and beyond other psychometric data. In addition, we summarize the results of a new meta-analysis intended to examine the capacity of these three instruments to detect child sexual abuse. Although some projective instruments were better than chance at detecting child sexual abuse, there were virtually no replicated findings across independent investigative teams. This meta-analysis also provides the first clear evidence of substantial file drawer effects in the projectives literature, as the effect sizes from published studies markedly exceeded those from unpublished studies. We conclude with recommendations regarding the (a) construction of projective techniques with adequate validity, (b) forensic and clinical use of projective techniques, and (c) education and training of future psychologists regarding projective techniques.
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Affiliation(s)
| | | | - Howard N. Garb
- Pittsburgh Veterans Administration Health Care System and University of Pittsburgh, Pittsburgh, Pennsylvania
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Coleman D, Lawrence R, Parekh A, Galfalvy H, Blasco-Fontecilla H, Brent DA, Mann JJ, Baca-Garcia E, Oquendo MA. Narcissistic Personality Disorder and suicidal behavior in mood disorders. J Psychiatr Res 2017; 85:24-28. [PMID: 27816770 PMCID: PMC5191918 DOI: 10.1016/j.jpsychires.2016.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
The relationship of Narcissistic Personality Disorder (NPD) to suicidal behavior is understudied. The modest body of existing research suggests that NPD is protective against low-lethality suicide attempts, but is associated with high lethality attempts. Mood-disordered patients (N = 657) received structured interviews including Axis I and II diagnosis and standardized clinical measures. Following chi-square and t-tests, a logistical regression model was constructed to identify predictors of suicide attempt. While there was no bivariate relationship of NPD on suicide attempt, in the logistic regression patients with NPD were 2.4 times less likely to make a suicide attempt (OR = 0.41; 95% CI = 0.19 - 0.88; p < 0.05), compared with non-NPD patients and controlling for possible confounding variables. NPD was not associated with attempt lethality. NPD patients were more likely to be male, to have a substance use disorder, and to have high aggression and hostility scores. Limitations include that the sample consists of only mood-disordered patients, a modest sample size of NPD, and the data are cross-sectional. The multivariate protective effect of NPD on suicide attempt is consistent with most previous research. The lower impulsivity of NPD patients and less severe personality pathology relative to other personality disorders may contribute to this effect. No relationship of NPD to attempt lethality was found, contradicting other research, but perhaps reflecting differences between study samples. Future studies should oversample NPD patients and include suicide death as an outcome. Clinical implications include discussion of individualized suicide risk assessment with NPD patients.
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Affiliation(s)
- Daniel Coleman
- Graduate School of Social Service, Fordham University, New York, NY, USA.
| | - Ryan Lawrence
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Amrita Parekh
- School of Social Work, Columbia University, New York, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, Autonoma University, CIBERSAM, Madrid, Spain
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - J. John Mann
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Enrique Baca-Garcia
- Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, Madrid, Spain
| | - Maria A. Oquendo
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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Stein MB, Slavin-Mulford J, Sinclair SJ, Chung WJ, Roche M, Denckla C, Blais MA. Extending the Use of the SCORS–G Composite Ratings in Assessing Level of Personality Organization. J Pers Assess 2016; 100:166-175. [DOI: 10.1080/00223891.2016.1195394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Michelle B. Stein
- Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School
| | | | - Samuel Justin Sinclair
- Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School
| | - Wei-Jean Chung
- Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School
| | | | | | - Mark A. Blais
- Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School
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Bram AD, Yalof J. Quantifying Complexity: Personality Assessment and Its Relationship with Psychoanalysis. PSYCHOANALYTIC INQUIRY 2015. [DOI: 10.1080/07351690.2015.987595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Ortigo KM, Westen D, Defife JA, Bradley B. Attachment, social cognition, and posttraumatic stress symptoms in a traumatized, urban population: evidence for the mediating role of object relations. J Trauma Stress 2013; 26:361-8. [PMID: 23696470 DOI: 10.1002/jts.21815] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research has linked multiple risk and resiliency factors to developing posttraumatic stress disorder (PTSD). One potentially important construct for understanding connections between trauma and PTSD is attachment. Although relationships between attachment and risk for PTSD have been described theoretically, limited research has addressed these relationships empirically. Furthermore, aspects of object relations overlap with attachment and PTSD, but have not been adequately incorporated in empirical research. One proposed pathway between attachment and PTSD involves the mediating role of object relations, particularly views of self and others. Present data were from a larger study investigating environmental and genetic risk factors for PTSD in an impoverished, primarily African American sample seeking care at a public urban hospital. Correlations indicated that adult attachment (with the exception of dismissing) and object relations relate to childhood traumas, (|r|s = .19-.29), adult traumas (|r|s = .14-.20), and self-reported PTSD symptoms (|r|s = .20-.36). Analyses also found support for mediational roles of object relations in relationships between attachment and PTSD symptoms (Model R(2) range = .136-.160). These data have theoretical, clinical, and research implications for understanding how particular aspects of attachment, specifically its effects on object relations, may protect against or predispose one to develop PTSD.
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Affiliation(s)
- Kile M Ortigo
- VA Palo Alto Health Care System, Palo Alto, California, USA; Department of Psychology, Emory University, Atlanta, Georgia 30322, USA.
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Inslegers R, Vanheule S, Meganck R, Debaere V, Trenson E, Desmet M, Roelstraete B. The Assessment of the Social Cognition and Object Relations Scale on TAT and Interview Data. J Pers Assess 2012; 94:372-9. [DOI: 10.1080/00223891.2012.662187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sekiya H, Sato A, Sakai Y, Naka Y, Suzuki K, Kashima H, Mimura M. Object relations in adolescence: a comparison of normal and inpatient adolescents. Psychiatry Clin Neurosci 2012; 66:270-5. [PMID: 22624731 DOI: 10.1111/j.1440-1819.2012.02353.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS We aimed to study the development of object relations in adolescents and their correlation with their mothers' defense styles in inpatient and normal adolescents. METHODS We administered the Thematic Apperception Test to adolescents in the adolescent unit (junior high, n = 16; senior high, n = 22) and normal controls (junior high, n = 16; senior high, n = 16). Results were analyzed using the Complexity of Representations Scale (CRS). We administered the Defense Style Questionnaire (DSQ(40)) to the subjects' mothers (patients, n = 38; controls, n = 32) to determine whether adolescents' CRS scores correlated with mothers' DSQ scores. RESULTS There was a nearly significant interaction for group-by-school-year for the children's CRS scores. In the control group, senior high school students' scores (mean [SD] = 3.52 [0.49]) were significantly higher (F [1,66] = 12.3, P = 0.001) than those of junior high school students' (mean [SD] = 3.03 [0.31]). In the patient group, no significant difference was observed between senior high and junior high. For mothers' DSQ(40), mature defense scores were significantly higher in the control group than in the patient group (mean [SD] = 10.8 [1.89] vs 9.35 [1.40] in junior high, and 11.8 [1.67] vs 9.36 [1.81] in senior high, F [1,66] = 22.1, P < 0.001, two-way ANOVA). A significant, positive correlation (r = 0.37, P = 0.04) was observed between the mothers' mature defense and the children's CRS scores in the control group only. CONCLUSIONS Whatever diagnoses are provided, the problems of adolescents with non-psychotic pathologies are related to the arrest of object relations development. A patient's mother cannot employ mature mechanisms to alleviate signals of anxiety sent by her child.
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Affiliation(s)
- Hideko Sekiya
- Department of Psychiatry, Kanto Central Hospital, Tokyo, Japan.
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22
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Stein MB, Siefert CJ, Stewart RV, Hilsenroth MJ. Relationship between the Social Cognition and Object Relations Scale (SCORS) and attachment style in a clinical sample. Clin Psychol Psychother 2010; 18:512-23. [DOI: 10.1002/cpp.721] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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23
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Thompson-Brenner H, Boisseau CL, Satir DA. Adolescent eating disorders: treatment and response in a naturalistic study. J Clin Psychol 2010; 66:277-301. [PMID: 19938166 DOI: 10.1002/jclp.20646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This naturalistic study investigated the treatment and outcome of adolescents with eating disorders (EDs) in the community. Clinicians from a practice-research network provided data on ED symptoms, global functioning, comorbidity, treatment, and outcome for 120 adolescents with EDs. ED "not otherwise specified" was the most common ED diagnosed. After an average of 8 months of treatment, about one third of patients had recovered, with patients with anorexia nervosa showing the most improvement. Clinicians utilized a range of psychotherapy interventions and two thirds of the patients had received adjunct psychoactive medication. Although CBT showed the strongest association with outcome in a subsample characterized by poor relational/personality functioning, dynamic therapy was associated with better global outcome in the overall sample.
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Affiliation(s)
- Heather Thompson-Brenner
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, Boston, MA 02215, USA.
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24
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Eurelings-Bontekoe EHM, Luyten P, Snellen W. Validation of a theory-driven profile interpretation of the Dutch short form of the MMPI using the TAT Social Cognitions and Object Relations Scale (SCORS). J Pers Assess 2009; 91:155-65. [PMID: 19205936 DOI: 10.1080/00223890802634274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this study, we investigated the construct validity of the theory-driven profile interpretation of the Dutch Short Form of the MMPI (DSFM; Luteijn & Kok, 1985), an interpretation method aimed at assessing structural features of personality based on Kernberg and Caligor's (2005) views concerning personality organization. We utilized the four dimensions of the Social Cognition and Object Relations Scale (SCORS; Westen, Lohr, Silk, Gold, & Kerber, 1990) as external criteria. Results showed that, congruent with theoretical expectations, the DSFM profiles predicted structural features of personality functioning, especially identity diffusion as measured by the SCORS, after adjustment for the effect of the single scales used to construct the profiles. These findings provide further support for the construct validity of the DSFM profiles to measure structural features of personality organization. We discuss directions for future research and clinical implications.
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Gong J, Miao D, Zhu X, Xiao W, Zhang Y. ANALYSIS OF DEMOGRAPHIC FACTORS ON F SCORES AND EVALUATION OF NEW CONFIGURATIONS OF F SCALES. SOCIAL BEHAVIOR AND PERSONALITY 2008. [DOI: 10.2224/sbp.2008.36.6.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analyzed the influence of demographic factors on scores of the Infrequency scale of the MMPI (Archer, Gordon, & Kirchner, 1987) administered to male youth in China. The demographic factors, acting as influencing factors of F scores, could be ignored. New configurations of infrequency
scales were presented and discussed, which indicated that it was appropriate to choose a 20% item endorsement percentage (IEP) of the Chinese male youth as the criterion for item selection.
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26
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Diguer L, Laverdière O, Gamache D. [For an empirical approach to object relations]. SANTE MENTALE AU QUEBEC 2008; 33:89-114. [PMID: 18795197 DOI: 10.7202/018474ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In this article, the authors address the concept of object relations and its place within psychodynamic theories regarding personality and, more specifically, in Kernberg's conceptualization of personality disorders and organization. The authors attempt to demonstrate the relevance of an empirical approach to object relations by presenting some of the instruments that are most considered. The Object Relations Rating Scale (ORRS ; Diguer, 2001), a new assessment instrument that is different from the others in that it assesses the therapeutic interaction as a whole, and that it is coherent with Kernberg's model of intervention and considers the overall relational manifestations. Finally, the authors present satisfying metrological ratings of this new instrument.
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Parental representations, object relations and their relationship to Depressive Personality Disorder and Dysthymia. PERSONALITY AND INDIVIDUAL DIFFERENCES 2007. [DOI: 10.1016/j.paid.2007.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
This article addresses a 2006 article by Hojnoski, Morrison, Brown, and Matthews on the use of performance-based measurement among school-based practitioners. Their results suggest that many of their survey respondents favor the use of this form of measurement. This line of research is important and addresses an important issue in current clinical practice. However, they offer a critique of this form of assessment, in response to which the author raises four issues. First, there is a difference between tests and techniques. Second, assessment tools do not make decisions or diagnoses; clinicians do. Third, actuarial prediction and clinical expertise are mutually enhancing. Last, the relationship between science and practice should be bidirectional and integrative. These points are discussed in terms of the utility and appropriateness of performance-based measurement tools and techniques for helping psychologists answer diagnostic, placement, and treatment questions in the school setting.
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Stein MB, Pinsker-Aspen JH, Hilsenroth MJ. Borderline pathology and the Personality Assessment Inventory (PAI): an evaluation of criterion and concurrent validity. J Pers Assess 2007; 88:81-9. [PMID: 17266418 DOI: 10.1080/00223890709336838] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study, we examined how patients diagnosed with borderline pathology (BP) would respond on the Personality Assessment Inventory (PAI; Morey, 1991) Borderline (BOR) scales in relation to patients without BP pathology. In addition, we examined whether the PAI BOR scales would be related to variables on the Social Cognition and Object Relations Scale (SCORS; Hilsenroth, Stein, & Pinsker, 2004; Westen, 1995) derived from early memory narratives. Results indicate that outpatients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnosis of BP scored significantly higher on the PAI BOR Total (BOR-Total) score, Identity Problems, and Self- Harm scales in comparison to a Non-BP clinical sample. The overall correct classification rate for the presence or absence of BP using the BOR Total scale (T >or= 70) was 73%. In addition, there were several significant relationships between dimensional PAI BOR scales and the presence versus absence of DSM-IV BP. Moreover, both the BOR-Total and Affect Instability scales were significantly related to the SCORS variable Complexity of Representations. We provide clinical examples to illustrate these research findings in an applied manner.
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Affiliation(s)
- Michelle B Stein
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA.
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30
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Peters EJ, Hilsenroth MJ, Eudell-Simmons EM, Blagys MD, Handler L. Reliability and validity of the Social Cognition and Object Relations Scale in clinical use. Psychother Res 2006. [DOI: 10.1080/10503300600591288] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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31
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A Freudian construct lost and reclaimed: The psychodynamics of personality pathology. PSYCHOANALYTIC PSYCHOLOGY 2006. [DOI: 10.1037/0736-9735.23.2.339] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Eudell-Simmons EM, Stein MB, DeFife JA, Hilsenroth MJ. Reliability and Validity of the Social Cognition and Object Relations Scale (SCORS) in the Assessment of Dream Narratives. J Pers Assess 2005; 85:325-33. [PMID: 16318572 DOI: 10.1207/s15327752jpa8503_09] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In this study, we aimed to investigate the application of an externally rated measure of interpersonal representations (Social Cognition and Object Relations Scale [SCORS]; Westen, 1995) to dream narratives. A total of 80 student participants enrolled at a private university in the New York City metropolitan area completed a Dream Log and affect adjective checklist (Wellman, 2002) based on a recalled dream at both 1 month and 3 months following the September 11, 2001, terrorist attacks. Using the dreams provided in this study we examined the interrater reliability of SCORS ratings, the relationship of SCORS variables to an independently rated measure of dream distortion, and the relationship of SCORS variables to participants' own ratings of dream affect. Results indicated that dreams were reliably rated using the SCORS, 3 cognitive SCORS variables were significantly related to dream distortion, and affective SCORS variables were meaningfully related to participants' own ratings of affect in their dreams. Findings from this study provide support for the application of SCORS ratings to dream narratives. We discuss implications for further research and clinical application.
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33
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Fowler JC, Ackerman SJ, Speanburg S, Bailey A, Blagys M, Conklin AC. Personality and Symptom Change in Treatment-Refractory Inpatients: Evaluation of the Phase Model of Change Using Rorschach, TAT, and DSM-IV Axis V. J Pers Assess 2004; 83:306-22. [PMID: 15548467 DOI: 10.1207/s15327752jpa8303_12] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In this study, we examined global treatment outcomes during 16 months of intensive, psychodynamic treatment for 77 inpatients suffering from treatment-refractory disorders. Hypotheses based on the phase model of treatment change (Howard, Lueger, Maling, & Martinovich, 1993; Howard, Moras, Brill, Martinovich, & Lutz, 1996) were supported in the study results. Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis V scales assessing behavioral functioning demonstrated large and medium effect size change, whereas stable, enduring personality functioning assessed by psychoanalytic Rorschach scales and the Social Cognition and Object Relations Scale (Westen, 1995) for the Thematic Apperception Test (Murray, 1943) demonstrated small and medium effect size change. We also report assessment of reliable change index and clinical significance. The ecological validity of Rorschach measures is supported by significant validity coefficients (in the hypothesized directions) between implicit measures of personality functioning and behavioral ratings.
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Affiliation(s)
- J Christopher Fowler
- The Erik H. Erikson Institute for Education and Research, The Austen Riggs Center.
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Abstract
The aim of this study was to investigate the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort Dysphoric Q-Factor with scales from the therapist, the patient, and independent observers. Therapists used the Shedler-Westen Assessment Procedure Q-Sort to describe their patients after the therapeutic assessment and the first two therapy sessions (when available). Independent observers completed a number of symptom distress, global functioning, and Axis II psychopathology measures after watching videotapes of the therapeutic assessment. They also completed a measure of social cognition and object relations after watching videotape of the therapeutic assessment and the first two therapy sessions (when available). Patients completed measures of symptomatology and personality assessment. Results indicated several significant correlations between the Dysphoric Q-Factor and a number of the clinician ratings of depressive symptomatology. In addition, three clinician ratings (Personality Disorder Index, Global Assessment of Functioning scale, and the experience and management of aggressive impulses variable of the Social Cognition and Object Relations Scale) demonstrated unique and nonredundant predictive ability in accounting for the variance of the Dysphoric Q-Factor. The patient self-report measures, however, did not correlate significantly with the Dysphoric Q-Factor, although several correlations demonstrated trends toward statistical significance.
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Affiliation(s)
- Marc J Diener
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA.
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35
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Price JL, Hilsenroth MJ, Callahan KL, Petretic-Jackson PA, Bonge D. A pilot study of psychodynamic psychotherapy for adult survivors of childhood sexual abuse. Clin Psychol Psychother 2004. [DOI: 10.1002/cpp.421] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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36
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Weise KL, Tuber S. The Self and Object Representations of Narcissistically Disturbed Children: An Empirical Investigation. PSYCHOANALYTIC PSYCHOLOGY 2004. [DOI: 10.1037/0736-9735.21.2.244] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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37
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Pessimism and failure in 6-part stories: indicators of borderline personality disorder? ARTS IN PSYCHOTHERAPY 2004. [DOI: 10.1016/j.aip.2004.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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38
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Abstract
In this paper, we review the empirical publications from the 1990s on the assessment of object relations (OR). Twelve different measures are referenced. Major findings of studies, conclusions, and evaluations of each measure are provided. In general, it was found that the most recent empirical literature has compared OR across diagnostic groups or evaluated therapy process and outcome by the quality of one's OR. Current strengths and limitations of the extant OR literature are provided, along with methodological recommendations to expand the utility and validity of OR assessment.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology and Neuroscience, Baylor University, PO Box 97334, Waco, TX 76798-7334, USA.
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39
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Callahan KL, Price JL, Hilsenroth MJ. Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample. J Pers Assess 2003; 80:173-84. [PMID: 12700020 DOI: 10.1207/s15327752jpa8002_06] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.
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Affiliation(s)
- Kelley L Callahan
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530, USA.
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40
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Baity MR, Hilsenroth MJ. Rorschach Aggressive Content (AgC) variable: a study of criterion validity. J Pers Assess 2002; 78:275-87. [PMID: 12067193 DOI: 10.1207/s15327752jpa7802_04] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study adds to the existing literature on the clinical utility of the Aggressive Content (AgC) variable proposed by Gacono and Meloy (1994). Criterion validity is evaluated by examining the relation between AgC and behavior. Rorschach and clinical chart material taken from psychological assessments were examined for 94 patients in Exner's (1993) psychiatric reference groups. An Aggression Chart Rating Scale (ACRS) was created to score the level of aggressiveness of each patient's diagnostic report. Analyses revealed good interrater reliability (intraclass correlation coefficient = .73) for ACRS scores and Aggressive Movement (AG; kappa = .73) and excellent reliability for AgC (kappa =.88) and Morbid Content (MOR: kappa = .79). Pearson's correlation revealed significant relations between AgC and both AG and MOR. All 3 Rorschach variables were significantly related to scores on the ACRS. A stepwise regression analysis utilizing these 3 variables resulted in AgC being the only nonredundant predictor of scores on the ACRS. This suggests that AgC was more strongly related to more aggressive ACRS scores than either AG or MOR. The continued support for the clinical utility of AgC as well as recommendations for the addition of the AgC variable to Exner's (1993) Comprehensive System's list of Special Scores are discussed.
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Affiliation(s)
- Matthew R Baity
- Department of Psychology, University of Arkansas, Fayetteville 72701, USA.
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41
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Garb HN, Wood JM, Lilienfeld SO, Nezworski MT. Effective use of projective techniques in clinical practice: Let the data help with selection and interpretation. ACTA ACUST UNITED AC 2002. [DOI: 10.1037/0735-7028.33.5.454] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Ackerman SJ, Hilsenroth MJ, Clemence AJ, Weatherill R, Fowler JC. Convergent validity of Rorschach and TAT scales of object relations. J Pers Assess 2001; 77:295-306. [PMID: 11693860 DOI: 10.1207/s15327752jpa7702_11] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The Rorschach Mutuality of Autonomy Scale (MOA) and the Social Cognition and Object Relations Scale (SCORS) have been shown to be reliable and valid measures of interpersonal functioning. Utilizing a sample of 57 outpatients with a Diagnostic and Statistical Manual of Mental Disorders Axis II diagnosis, this study extends the findings of previous research demonstrating the reliability and convergent validity of each measure. Analyses focused on the convergent validity between the Rorschach MOA Scale and 8 SCORS variables (complexity, affect, emotional investment in relationships, emotional investment in values and morals, understanding of social causality, management of impulses/aggression, self-esteem, identity/coherence of self) ratings of Thematic Apperception Test narratives. The conceptual nature and clinical utility of these findings are discussed in relation to psychological assessment.
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Affiliation(s)
- S J Ackerman
- Massachusetts Mental Health Center and Harvard Medical School, Boston 02115, USA.
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43
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Petot JM. Interest and limitations of projective techniques in the assessment of personality disorders. Eur Psychiatry 2000; 15 Suppl 1:11-4. [PMID: 11520468 DOI: 10.1016/s0924-9338(00)00500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Assessing personality disorders (PD) remains a difficult task because of persistent problems linked to concurrent validity of existing instruments, which are all structured interviews or self-report inventories. It has been advocated that indirect methods, projective techniques in particular, can strengthen PD assessment methods. The thematic apperception test (TAT) may be a significant adjuvant method of PD assessment.
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Affiliation(s)
- J M Petot
- Laboratoire Psychologie clinique des faits culturels, Département de Psychologie, Université Paris X-Nanterre, 200, avenue de la République, 92001 Nanterre, France.
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