1,721,049 research outputs found
Comprendere i disturbi mentali. Una guida per la famiglia con l'aiuto del DSM-5
No full textIl libro fornisce preziose informazioni su tutto ciò che riguarda la malattia mentale e la sua cura. Presenta i disturbi usando un linguaggio comprensibile per lettori senza formazione psichiatrica, per esempio genitori che potrebbero voler capire quali opzioni sono possibili per il trattamento del loro bambino. Spesso la descrizione è accompagnata da un breve case study su un paziente sottoposto a trattamento per un determinato disturbo, che serve come esempio per orientarsi in casi analoghi. Il lettore avrà la possibilità di riconoscere i sintomi psichiatrici, di capire quando è il momento di chiedere aiuto per ottenere le cure adeguate. Tra i differenti disturbi illustrati vi sono la depressione, la schizofrenia, il disturbo da deficit di attenzione/iperattività, il disturbo dello spettro dell’autismo, il disturbo da stress post-traumatico e il disturbo bipolare. Il volume, basato sul DSM-5® (quinta e ultima edizione del Manuale diagnostico e statistico dei disturbi mentali), offre anche un glossario, suggerimenti per affrontare il disagio e una lista di risorse utili per il trattament
Prevedere l’esito dei trattamenti psicoanalitici con la Computerized text analysis measure of reflective functioning
No full textA CONTRIBUTION TO THE ITALIAN VALIDATION OF THE THERAPIST RESPONSE QUESTIONNAIRE FOR ADOLESCENTS (TRQ-A)
No full textClinical report suggests that therapists have strong and difficult-to-manage reactions to adolescent patients with personality pathology; however, systematic research is largely absent. The aim of this study was to examine the stability of the factor structure and psychometric properties of the Therapist Response Questionnaire for Adolescent (TRQ-A; Betan et al.,
2005; Satir et al., 2009), a clinician report instrument able to measure the clinician’s emotional reactions to the adolescent patient in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 115) of psychodynamic and cognitive– behavioral orientation completed the TRQA, as well as the Shedler-Westen Assessment Procedure-200 for adolescent
(SWAP-200-A; Westen et al., 2003), to assess personality disorders and level of psychological functioning, regarding a patient currently in their care. Factor analyses revealed 6 distinct countertransference factors that were not very similar to 6 dimensions identified in the original version of the measure: (a) overwhelmed/disorganized, (b) hostile/criticized, (c)
positive/satisfying, (d) overinvolved/protective, (e) helpless/inadequate, and (f) disengaged. These scales showed excellent internal consistencies and good validity. They were especially able to capture the quality and intensity of emotional states that therapists experience while treating adolescent patients with personality pathology. The results seem to confirm that TRQ-A
is a valid and reliable instrument that allows to evaluate patterns of countertransference responses in clinically sensitive and psychometrically robust ways, regardless of therapists’ orientations. The clinical and research implications of these findings are addressed
Does the reflective functioning mediate the relationship between attachment and personality?
No full textA growing body of research seems to support that attachment insecurity and reflective functioning (RF) deficits can play a crucial role in the understanding of the psychopathological factors that underlie personality pathology. Attachment theory provides a comprehensive developmental perspective to get a more articulate awareness of relational and affect-regulatory patterns related to personality disorders (PDs). Likewise, RF impairments were found to be associated with the severity of a wide range of mental disorders, mostly the borderline conditions (Bateman & Fonagy, 2016). However, our knowledge about the impact of attachment security/insecurity and RF on the personality and its functioning is not conclusive. The aim of this study was to examine: (1) the association between the levels of RF and the cluster A, B and C personality disorders, as well as personality functioning; and (2) the possible mediated effect of RF on the relationship between attachment and personality functioning. The sample consisted of N=90 outpatients recruited through clinical private practice networks and public mental health services. Each patient was interviewed with the Adult Attachment Interview (George et al., 1985) and the AAI transcripts were assessed with the RF Scale (Fonagy et al., 1998). Moreover, the Clinical Diagnostic Interview (Westen, Muderrisoglu, 2003) was administered to apply the Shedler-Westen Assessment Procedure-200 (Westen, Shedler, 1999) for the personality evaluation. Overall, the findings showed that lower levels of RF and attachment insecurity are mostly related to patients with cluster A and B personality pathology; conversely, greater levels of RF and attachment security are related to higher personality functioning. Moreover, it seems that patients’ RF mediates the relationship between attachment and high-functioning of personality suggesting that the impact of RF is more sizable than attachment. The clinical implications of these findings were addressed
Attachment patterns, mentalization and childhood traumatic experiences in a sample of adolescence at ultra high risk for psychosis
No full textThe ultra-high risk (UHR) criteria were defined to identify young people at high and imminent risk of developing a first episode of psychosis. Identifying UHR individuals presents the opportunity for preventing the onset of a full psychotic disorder, or at least the possibility of reducing patient’s disability. The link between insecure attachment and the risk for developing psychosis has been explained by the alterations of specific neurobiological pathways. Some studies also underlined the role of mentalization processes in moderating the risk of transition to psychotic disorders. Nevertheless, to date, attachment and mentalization in UHR population have not been studied using “golden standard” measures. The aim of this study was to explore the quality of attachment representations, mentalization capacity and childhood traumatic experiences among UHR adolescence outpatients.
Methods: 21 UHR adolescent outpatients were compared with 33 other who didn’t meet the ultra-high risk criteria. Each patient was evaluated with M.I.N.I., Childhood Trauma Questionnaire, Structured Interview for Prodromal Syndromes (SIPS/SOPS). During the first month of treatment the Adult Attachment Interview was also administered, and the AAI transcripts were assessed by the RF Scale. Results: Although no differences between groups with respect to self-reported childhood traumatic experiences have been found, UHR patients showed a higher degree of low-coherence cannot classify attachment patterns. Moreover, the RF scores were significantly lower in the UHR sample and significant negative correlations between RF and two SOPS’ subscales, “Suspiciousness/Persecutory Ideas” and “Expression of Emotion” were found.
Conclusions: Our results underline the importance of taking both disorganized attachment and mentalization impairment into consideration when treating psychotic prodromal symptomatology
Stigma and attitudes towards restrictive practices in Psychiatry among Psychology students: a network and path analysis study in an Italian sample
No full textMentalization as a predictor of psychoanalytic outcome: An empirical study of transcribed psychoanalytic sessions through the lenses of a computerized text analysis measure of reflective functioning
No full textThe Reflective Functioning (RF) scale (Fonagy, Target, Steele, & Steele, 1998) was developed to empirically assess the capacity to mentalize thoughts, intentions, feelings and beliefs of oneself and others in the context of attachment relationships (Jurist & Meehan, 2009). To overcome the complexity of the RF scale scoring, the Computerized text analysis measure of Reflective Functioning (CRF) was created by Fertuck and colleagues (2012). We report the results of a preliminary study applying the CRF to a sample of 540 sessions comprising 27 psychoanalytic treatments. Results show that patients’ reflective functioning (RF), as measured at the beginning of treatment, was positively correlated with two global measures of healthy personality functioning (GAF [American Psychological Association, 2000] and PHI [Waldron et al., 2011]), as measured at the end of treatment, and with an increase in PHI and GAF from early to late sessions. Even when the PHI and GAF levels at the beginning of treatment were controlled for, these correlations remained significant. At the same time, the RF of patients did not increase throughout treatment. The implications of these results and the validity of CRF as an outcome predictor of long-term psychoanalytic treatment are discussed
Patient personality dimensions and transference patterns: An empirical investigation
No full textIntroduction: Since Freud (1912, 1917) first recognized that patients
displace intense feelings and conflicts associated with a significant
figure of childhood onto the analyst, actualizing in therapy
their dysfunctional patterns of relatedness, the concept of transference
has revised radically. Beyond the theoretical divergences,
as well as the technical controversies related to the use of transference
interventions across various treatment (Bateman, Fonagy,
& Gabbard, 2007; Gelso & Bhatia, 2012; Gilbert & Leahy, 2007;
Høglend, 2014; Yeomans, Clarkin, & Kernberg, 2015), in the contemporary
terms, it refers to a patient’s patterns of feeling, thought,
perception, motivation, and behavior that emerge within the therapeutic
relationship, and reflects enduring aspects of the patient’s
personality functioning (Westen & Gabbard, 2002). Clinicians of
all theoretical orientations should pay particular attention to these
ubiquitous phenomena that provide valuable information on patients’
core psychological dynamics (Gabbard, 2014; Høglend,
2014; Kernberg, 1984; Lingiardi & McWilliams, 2017; McWilliams,
2011). To date, only a few empirical investigations have examined
the relationship between transference patterns and patients’ personality
pathology. Overall, research findings indicated that patients
with Cluster A and B personality disorders, compared to Cluster C
patients, tend to enact more dysfunctional and difficult to manage
relational patterns in therapy; moreover, among Cluster B, borderline
patients showed mixed and intense transference responses in
therapy (e.g., Bradley, Heim, & Westen, 2005; Bourke & Grenyer,
2010; Colli, Tanzilli, Gualco, & Lingiardi, 2016; Drapeau & Perry,
2009; Drapeau, Perry, & Koerner, 2010; Ruiz, Pincus, & Bedics,
1999; Stern, Herron, Primavera, & Kakuma, 1997). However, no
research has considered the associations with personality dimensions
or traits. The present study attempted to bridge this gap using
a dimensional diagnostic approach based on a multifaceted model of personality syndromes: the SWAP Personality Dimension Scales
(Shedler & Westen, 2004). These personality dimensions showed
psychometrically robust characteristics and clinical sensitivity to
capture the complexity of personality pathology (see Westen &
Muderrisoglu, 2006). Method: A national sample of clinicians of
different theoretical orientations (N=90) completed the Psychotherapy
Relationship Questionnaire (PRQ; Bradley et al., 2005; Westen,
2000) to identify transference patterns, and the Shedler-Westen
Assessment Procedure-200 (SWAP-200; Shedler & Westen, 2004;
Shedler, Westen, & Lingiardi, 2014) to assess personality dimensions
regarding a patient currently in their care. Notably, in this
study we used (a) the empirically supported PRQ version (Tanzilli,
Colli, Gualco, & Lingiardi, 2018), that consists of six transference
dimensions characterized by excellent internal consistency
(Streiner, 2003): hostile (α=.93), positive/working alliance
(α=.88), special/entitled (α=.84), anxious/preoccupied (α=.82),
avoidant/dismissing attachment (α=.81), and sexualized (α=.88);
and (b) the twelve SWAP Personality Dimension Scales identified
by Shedler and Westen (2004) performing a factor analysis to all
the SWAP-200 items: psychological health; psychopathy; hostility;
narcissism; emotional dysregulation; dysphoria; schizoid orientation;
obsessionality; thought disorder (or schizotipy); oedipal conflict
(or histrionic sexualization); dissociation; and sexual conflict.
Results: Bivariate correlations showed that distinct SWAP personality
dimension scales were significantly associated with specific
transference patterns. Notably, the SWAP hostility and psychopathy
were positively related to hostile transference, while the SWAP narcissism
correlated with special/entitled pattern. Positive/working
alliance pattern was negatively related to the SWAP schizoid orientation,
while the SWAP dysphoria correlated positively with anxious/
preoccupied transference. Avoidant/dismissing attachment
pattern was negatively and strongly related to the SWAP emotional
dysregulation, and positively associated with both SWAP schizoid
orientation and narcissism. Finally, sexualized transference was related
to the SWAP sexual conflict. Conclusions: These results
showed that transference patterns are coherently and meaningfully
related to patients’ personality features, confirming the diagnostic
value of these clinical phenomena as an essential tool in understanding
personality traits/dimensions that underlie the patients’
pathology. The implications for clinical practice are apparent given
that these findings inform clinicians of all theoretical approaches
about the interpersonal patterns that can be activated by their patients
during psychotherapy, providing a roadmap for effective therapeutic
intervention and decision making.. Moreover, this study
supports the potential strengths of the PRQ’s use in both empirical
and clinical contexts.
References
Bradley, R., Heim, A. K., & Westen, D. (2005). Transference patterns in the psychotherapy
of personality disorders: Empirical investigation. The British
Journal of Psychiatry, 186, 342–349. doi:10.1192/bjp.186.4.342
Høglend, P. (2014). Exploration of the patient–therapist relationship in psychotherapy.
The American Journal of Psychiatry, 171, 1056–1066.
doi:10.1176/appi.ajp.2014.14010121
Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic Diagnostic Manual,
2nd ed. (PDM-2). New York, NY: Guilford Press.
Tanzilli, A., Colli, A., Gualco, I., & Lingiardi, V. (2018). Patient personality and
relational patterns in psychotherapy: Factor structure, reliability, and validity
of the Psychotherapy Relationship Questionnaire. Journal of Personality
Assessment, 100(1), 96-106. doi:10.1080/00223891.2016.1272050
Tanzilli, A., Lingiardi, V., & Hilsenroth, M. (2018). Patient SWAP-200 Personality
Dimensions and FFM Traits: Do They Predict Therapist Responses?. Personality
Disorders: Theory, Research, and Treatment, 9(3), 250–262.
doi:10.1037/per000026
Clinical assessment of personality and attachment patterns in adolescents at ultra high risk for psychosis
No full textIntroduction: “Ultra-high risk” (UHR) diagnostic criteria (Miller et al., 2003) pinpoint a combination of state (attenuated or brief intermittent positive psychotic symptoms) and trait (genetic risk with a deterioration in functioning) risk factors that identify youth and young adults at heightened and imminent risk of developing a first episode of psychosis. Identifying UHR individuals can help guide mental health practitioners in their treatment decision-making and adapt their interventions to the individual characteristics of patients in order to prevent the onset of psychosis. Nevertheless, UHR population is highly heterogeneous, displaying varying clinical conditions, including anxiety, depression and substance disorders. As this heterogeneity undermines both clinical research and the evaluation and treatment of patients, many mental health care providers ex- press concern with the current diagnostic practice, which does not enable efficacious therapeutic planning. In particular, according to epidemiological data, has been shown that about 40% of UHR patients receive at least one diagnosis of personality disorder. Although some common genetic and environmental diatheses underlie both schizotypal personality disorders and schizophrenia, some studies have shown the rates of schizotypal UHR patients to be relatively modest. In contrast, other studies have found a considerable prevalence of schizoid, borderline and avoidant personality traits/disorders among UHR patients (Shurze-Lutter et al., 2012). So far, only few studies have thus evaluated personality features in the UHR population, suggesting that the personality characteristics of such patients vary considerably. To our knowledge, these personality differences have never been systematically evaluated. Furthermore, there are evidences linking attachment adversity to psychosis, from the premorbid stages of the disorder to its clinical forms. To date, very little research has evaluated attachment patterns in UHR individuals. In each case, the researchers used exclusively self-report instruments and detected a high rate of insecure patterns (e.g., 93% in Quijada et al., 2015; and 95% in Russo et al., 2018). We consider a systematic investigation of the UHR population critical for improving our understanding of the different symptom patterns of UHR individuals and achieving more accurate diagnoses. We aim to conduct such an investigation by: (1) examining the full spectrum of person-specific psychopathology and its manifestation in patient personality structures, under the assumption that symptoms take different meanings and roles according to the larger context of patient personality functioning. (2) investigating attachment patterns using the gold standard measure for attachment. Methods: 40 adolescent UHR outpatients were compared to 40 individuals who
didn’t meet the ultra-high risk criteria. The recruited patients’ treating clinicians were also involved and asked to provide basic demo- graphic and diagnostic data, and to complete clinician-report assessment tools. Each patient received a DSM personality diagnosis and was assessed using the Brief Psychiatric Rating Scale (BPRS). The Structured Interview for Prodromal Syndromes (SIPS/SOPS) has been administered to assess prodromal symptoms. According to the SIPS, UHR participants must meet one of three criteria: (1) increasing but attenuated positive symptoms; (2) a recent, brief psychotic episode that is too short in duration to meet diagnostic criteria for a psychosis disorder; or (3) a first-degree relative with psychosis, and recent functional decline. The Adult Attachment Interview (AAI), a semi-structured interview used to assess individuals’ “state of mind” or internal working models with respect to attachment relationships, was administered to each patient. The AAI interviews have been audio recorded, transcribed verbatim, and coded by two independent certified coders who were blind to all other study conditions. Childhood trauma has been coded from the verbatim transcripts of the AAI by two independent raters, according to the clinical version of the Complex-TQ, a questionnaire aimed to assess multi-dimensional features of childhood trauma. Finally, treating clinicians were supervised by the researchers for evaluate patients’ personality trait and disorders, according to the SWAP-200, a well- established and widely used psychometric procedure that provides a comprehensive assessment of personality and personality pathology. Results: No differences between groups have been found when personality disorders were measured according to the DSM-IV-TR categories. However, UHR patients showed more impaired personality functioning and higher scores on two Q-factors of the SWAP- 200: “inhibited/self-critical” and “emotionally dysregulated”. Finally, a higher degree of “cannot classify low-coherence” attachment pat- terns was found in UHR patients’ group. Conclusions: These primary findings seem to suggest the importance of taking into account the emotional dysregulation, social inhibition and disorganized attachment in treatment planning of UHR patients. To date, the intervention strategies available to significantly change the clinical course of UHR conditions have proven to be poorly effective in follow-ups longer than 12 months (Davies et al., 2018). Preliminary results this study seem to suggest that attachment-informed psychotherapy, tailored to the personality characteristics of patients, may be an effective preventive treatment for UHR patients
Patient Personality Dimensions, Relational Patterns, and Therapeutic Alliance in Clinical Practice: An Empirical Investigation
No full textIntroduction: Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients’ personality maladaptive traits in psychotherapy. Methods: A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler-Westen Assessment Procedure-200 (SWAP-200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients, and the Working Alliance Inventory (WAI-T) to evaluate quality of therapeutic alliance.
Results: Overall, the most severe and maladaptive dimensions of patients’ personality were associated with more negative clinician-patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance.
Conclusions: Findings support that therapists’ careful understanding of patients’ interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes
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