509 research outputs found
PATIENT EMERGING PERSONALITY PATTERNS AND DEFENSE MECHANISMS IN THE TREATMENT OF ADOLESCENTS WITH DEPRESSIVE DISORDERS: A PSYCHODYNAMIC DIAGNOSTIC MANUAL-ORIENTED EMPIRICAL INVESTIGATION
No full textIntroduction: In recent years, the incidence of depressive disorders is significantly increased in the
adolescent population. Alarmingly, their spread appears to be even underestimated given that several
cases of adolescent depression are not identified, accurately assessed, or dealt with in a timely and
effectively manner. Thus, international health institutes and systems have recognized the
urgent need to pay particular attention to early detection and prevention policies, as well as to
the promotion of the best practices for the treatment of these disorders in adolescents
Moreover, research has shown that depressive pathologies in adolescence represent a broad and more
heterogeneous diagnostic grouping , and they co-occur with personality disorders. Moreover, this
comorbidity seems to be associated with poorer therapeutic outcomes. This evidence highlights the
need to pay particular attention to personality characteristics of this clinical population. Moreover, the
assessment of the adolescents’ defensive style is also thought to contribute to an accurate
psychodynamic-oriented diagnosis, considering its strong association with both personality pathology
and depressive symptomatology. Lastly, specific therapists’ emotional responses (or
countertransference) towards the patients is deemed to strongly inform about the adolescents’
intrapersonal and interpersonal functioning. Starting from these premises, the current study aimed at
exploring the relationship between patients’ emerging personality patterns, defenses mechanism, and
the therapists’ emotional responses in the treatment of adolescents with depressive disorders
according to the Psychodynamic Diagnostic Manual-2 (PDM-2) framework.
Method: One hundred clinicians completed the Psychodiagnostic Chart-Adolescent of the PDM-2 to
provide a comprehensive assessment of psychological functioning of a depressed adolescent patient in
their care. They also filled in the Therapist Response Questionnaire for Adolescents to investigate
their countertransference responses towards patients. Moreover, adolescent patients completed the
Defense Mechanism Rating Scales Self-Report-30 to evaluate their defensive functioning.
Results: Four emerging personality profiles related to depressive pathology in adolescence were
identified: depressive/introjective, anxious–avoidant, emotionally dysregulated, and narcissistic. These
emerging personality patterns were characterized by distinct intrapsychic and interpersonal dynamics
which were able to better differentiate this broad and more heterogeneous diagnostic grouping. For
instance, depressive symptoms in the context of depressive/introjective emerging personality pattern
were usually associated with feelings of guilt and perfectionism, whereas those ―embedded‖ in the
narcissistic emerging personality pattern were mostly related to severe self-esteem problems.
The results also showed that the emotionally dysregulated and narcissistic emerging personality
patterns were significantly related to the borderline personality organization, whereas the
depressive/introjective and anxious–avoidant emerging personality patterns were associated with the
neurotic level of personality organization. Regarding to defensive functioning, adolescents presenting
with the emotionally dysregulated and narcissistic personality patterns tended to use more immature
defense mechanisms, especially major and minor image-distorting defense levels respectively.
Conversely, patients with depressive/introjective emerging personality pattern tended to use neurotic
and minor image-distorting defenses, whereas those presenting with anxious–avoidant emerging
pattern mainly used neurotic defense mechanisms. Finally, countertransference patterns were
significantly related to patients’ emerging personality patterns in a clinically meaningful and
systematically predictable manner. Adolescent patients showing the emotionally dysregulated and
narcissistic personality patterns tended to elicit in their clinicians more negative emotional reactions
characterized by anger, irritation, worry, and sense of inadequacy. On the contrary, the depressiveintrojective
and anxious-avoidant emerging personality patterns were associated with less intense and
difficult-to-manage countertransference reactions. In particular, anxious-avoidant patients evoked
protective reactions in therapists.
Conclusions: The present study sought to extend the current knowledge on the emerging personality
patterns in the context of depressive disorders in adolescent patients, providing meaningful
information to their psychological functioning. According to a psychodynamically-oriented
assessment, the evaluation of defensive functioning also helps to deepen the understanding of selfregulation
strategies in dealing with emotional conflicts and to internal or external stressors. Lastly, the
nuanced view of countertransference reactions evoked by these patients in psychotherapy offers the
opportunity to improve diagnostic accuracy and guide clinicians in planning effective therapeutic
interventions. Overall, all the clinicians of different therapeutic orientations should use the
information derived from an accurate psychodynamic assessment to generate clinically meaningful
diagnoses and promote treatments tailored on adolescents’ psychological functioning other than on
their manifest symptomatology. The new PDM-3 will include the findings of this research project in
order to provide a more complex and articulated perspective of depressive disorders in adolescence
Navigating the complexities of the psychotherapy process: a multi-method investigation on the role of therapist responsiveness
No full textUnderstanding how treatment works is a crucial objective in psychotherapy research. Studies have highlighted the therapist effects on the psychotherapy process; however, there is still a gap on the specific role of the clinicians’ interpersonal skills. This thesis focused on therapist responsiveness—the capacity to effectively meet patients’ needs—and examined its relationship with other critical factors, such as therapeutic alliance, therapist emotional responses, and session outcomes measured in terms of depth of elaboration. Therapist-patient dyads completed self-report instruments and responded to open-ended questions. Study One found that therapist responsiveness was a more robust predictor of depth of elaboration than therapeutic alliance underscoring its significance. Mixed models were used considering the nested data structure. Study Two focused on the therapist perspective, revealing that deeper sessions were characterized by greater therapist responsiveness and positive countertransference whereas shallower sessions showed lower responsiveness and more negative countertransference. In Study Three a thematic analysis identified core aspects of therapist responsiveness within sessions. Responsive moments were marked by therapist attunement and insight promotion, while non-responsive moments involved feelings of inadequacy, misattunement, and disagreement on treatment objectives. Study Four applied network analysis to therapist responsiveness, therapeutic alliance, and depth of elaboration as evaluated by both therapists and patients. Interconnections between variables underscored that the therapeutic relationship can be better viewed as a complex system where both members reciprocally influence each other. Overall, therapist responsiveness emerged as a pivotal factor in promoting positive outcomes. Converging findings across various methodologies enriched our understanding on the mechanisms of change in psychotherapy underscoring the need for tailored interventions that address patients’ needs
Personality syles, depressive disorders and therapist responses in adolescent psychotherapy: A PDM-2 empirically oriented and clinically meaningful investigation.
No full textIntroduction: The assessment of personality pathology and depressive disorders in adolescence is very challenging due to the high prevalence and comorbidity of these psychopathological conditions in young people. This study explored the relationship among personality patterns, depressive disorders, and therapists’ responses in adolescent treatment according to the PDM-2 diagnostic framework. Method: Fifty clinicians completed the Psychodiagnostic Chart-Adolescent, the Shedler-Westen Assessment Procedure-II for Adolescents and the Therapist Response Questionnaire for Adolescents to provide a comprehensive assessment of psychological functioning and countertransference responses of an adolescent patient in their care. Results: Four emerging personality profiles related to depressive pathology in adolescence were identified: depressive/introjective, anxious–avoidant, emotionally dysregulated, and narcissistic. The latter two subtypes significantly correlated with a borderline personality organization, whereas the others showed a trend toward significance with a neurotic level of personality organization. Moreover, adolescents presenting with emotionally dysregulated and narcissistic personality patterns tended to evoke negative emotional reactions characterized by anger, irritation, worry, and sense of inadequacy. Patients with depressive/introjective pattern elicited less intense and negative countertransference reactions, whereas patients with anxious–avoidant pattern tended to evoke protective reactions in their clinicians. Conclusions: The study extends knowledge on emerging personality patterns related to depressive disorders in adolescents, and provides a nuanced view of countertransference reactions evoked by these patients in psychotherapy. Therapists should use the information derived from the therapeutic relationship to generate clinically meaningful diagnosis and promote treatments tailored on adolescents’ psychological functioning
Bibliographie : Octavia römische Geschichte. Zugabe des ersten Theils, [vol. 2] (Nürnberg: J. Hoffmann, 1678)
No full textZweiter Band der ersten Fassung der "Römischen Octavia". Cf. zur vollständigen Publikationsgeschichte: Octavia römische Geschichte, [vol. 1] (Nürnberg: J. Hoffmann, 1677). Enthält mehrere teils wahrscheinlich, teils sicher autorfremde Gedichte. Zwei davon stammen von Christian Hofmann von Hofmannswaldau (vgl. HKA I, pp. CLXXIVf., Anm. 195). Von der "Geschichte der Flavia Domitilla und der Cönis", pp. 920-1015, existiert eine Übersetzung einer unbekannten französischen Hofdame ins Französische, datiert auf den 9. März 1714 (23: Cod.Guelf. 196.1 Extravag.)
Two shades of narcissism: correlations between narcissistic dimensions, defense mechanisms, mentalization, and social mentalities
No full textIntroduction. The discussion on narcissism has characterized much of the psychological literature of the
twentieth century. Nonetheless, narcissism remains a quite enigmatic construct. Our understanding of
its variants is limited, and there is significant divergence in the definition of the cognitive, emotional,
motivational, and behavioral processes that underlie them. These limitations are reflected in the recent
critiques of its diagnostical criteria, which do not fully capture the complexity and nuances of this
pathology. In recent years, however, Back and colleagues (2013, 2018) have proposed a model that
distinguishes two dimensions of narcissism: admiration (characterized by self-enhancing strategies,
such as striving for uniqueness and grandiose fantasies, and charmingness) and rivalry (characterized
by self-defensive processes such as striving for supremacy, devaluation of others, and aggressiveness),
advancing our knowledge of the phenomenon. This study aimed to investigate, in a non-clinical
sample, how these different dimensions of narcissism correlate with other aspects of mental
functioning, such as defensive mechanisms, mentalization, and social mentalities (i.e., affective,
cognitive, and behavioral patterns that underlie basic interpersonal motivational systems) – so as to
shed light on the intra- and inter-personal dynamics that characterize narcissistic functioning.
Methods. The study was carried out through an online survey. Participants were recruited through
snowball sampling – i.e., via email invitation and diffusion through social media. The survey consisted
of 1) an ad hoc questionnaire designed to collect socio-demographic data; 2) the Narcissistic
Admiration and Rivalry Questionnaire (NARQ; Back et al., 2013); 3) the Defense Mechanism Rating
Scales Self-Report (DMRS-SR-30; Di Giuseppe et al., 2020); 4) the Reflective Functioning
Questionnaire (RFQ-8; Fonagy et al., 2016); and 5) the Social Mentalities Scale (SMS; Brasini et al.,
2015). A total of 478 participants (309 males and 169 females) between 18 and 30 years old (M=23.6; SD = 2.54) took part in the study. All statistical analyses were performed using IBM SPSS Statistics 27.0. Pearson’s correlation coefficients were calculated to investigate the relationship between narcissism dimensions – evaluated through the NARQ – and defense mechanisms, mentalization, and
social mentalities. The criterion for significance was set at p=0.05 for all analyses.
Results. Individuals with higher levels of narcissistic traits showed lower levels of overall defensive
functioning (ODF); that is, they tended to employ more maladaptive defense mechanisms. Rivalry
traits presented greater positive correlations with immature defense mechanisms such as action (acting
out, help-rejecting complaining, passive aggression), major image-distorting (projective identification,
splitting of self-image, splitting of other’s image), and disavowal (denial, projection, rationalization,
autistic fantasy). Minor image-distorting defenses showed positive correlations with all dimensions of
narcissism. Concerning mentalization, admiration traits correlated with uncertainty about mental
states, suggesting a limited and simplistic engagement in mentalizing activities; instead, rivalry traits
correlated with certainty about mental states, suggesting excessive confidence in one’s mentalizing
capacity, defined as hyper- or pseudo-mentalizing. Regarding social mentalities, both rivalry and
admirations showed significant correlations with agonism. Admiration traits were also positively
correlated with prosociality, affiliation, sexuality, and play, and negatively correlated with insecurity,
suggesting that this form of narcissism is characterized by the tendency to show pseudo-altruism and
pseudo-concern about others to attain social prestige and a sense of belongingness, and at the same
time by a tendency to negate feelings of vulnerability, inadequacy, and need for care. On the contrary,
rivalry traits correlated positively with insecurity and negatively with prosociality, indicating that
individuals with this form of narcissism show a tendency to experience feelings of vulnerability and
neediness, as well as self-criticism, self-devaluation, and shame, and therefore a tendency to withdraw
from positive social interactions.
Conclusion. Our findings hold significant implications for a more thorough understanding of the intra-
and inter-personal processes that underlie different forms of narcissism and, consequently, of the
different transference and countertransference dynamics that might characterize psychotherapeutic
interventions with patients possessing narcissistic traits
Therapist responsiveness and clinical relationship in the treatment of patients with personality disorders: An empirical investigation
No full textIntroduction: Therapist responsiveness refers to a crucial component of the clinician-patient relationship,
defining how the therapist is with the patient and manifests flexibility, sensitivity, empathy, and
availability. Being a responsive therapist means getting emotionally attuned to the patient, being able to
read the interpersonal dynamics developing in the hic et nunc of the clinical interaction, and providing
the most appropriate interventions consistent with the emerging relational context. Recent studies have
emphasized the impact of this dimension in the treatment of patients with personality disorders (PD),
but knowledge in this field of investigation is very limited. This research aimed to investigate the
association between therapist responsiveness and some characteristics of the therapist, patient, and
clinical relationship in the early stages of the psychotherapy. Methods: 82 pairs of therapists and patients
(with PD) completed two instrument batteries consisting of the patient and therapist versions of the
Patient’s Experience of Attunement and Responsiveness Scale, the Working Alliance Inventory-SF, the
Depth Scale of the SEQ, respectively. The therapists’ battery also included the Therapist Response
Questionnaire and the Comparative Psychotherapy Process Scale, while the patients’ battery included the
Defense Mechanisms Rating Scale-SF-30. Results: Overall, therapist responsiveness was related to the
quality of the therapeutic alliance and the depth of content processing that emerged during the
psychotherapy sessions. Good therapist responsiveness was strongly associated with the use of
psychodynamic techniques. A negative correlation was found between therapist responsiveness,
helpless/inadequate and disengaged countertransference patterns, and patients’ worse defensive
functioning. Finally, a statistically significant patient-therapist divergence was found in the assessment of
therapist responsiveness. Patients tended to evaluate therapists’ responsiveness more positively than the
clinicians themselves. Discussion: This study seeks to shed light on the interpersonal processes in the
patient-therapist dyads that help guide the therapeutic process toward better outcomes. The findings have clinically significant implications and promote the development of best practices for planning effective
individualized treatments for patients with PD
ASSESSING BORDERLINE PERSONALITY DISORDER IN ADOLESCENCE ACCORDING TO THE PSYCHODYNAMIC DIAGNOSTIC MANUAL-2 (PDM-2) CLINICAL FRAMEWORK
No full textAssessing borderline personality disorder (BPD) in adolescence is very difficult due to its high symptom
heterogeneity and severity. This study aimed to provide an empirically valid and clinically rich portrait of
BPD identifying specific subtypes in borderline adolescent patients according to the PDM-2 framework. Fifty
clinicians completed the Psychodiagnostic Chart-Adolescents of the PDM and the Therapist Response Questionnaire-Adolescents. Patients filled in the Defense Mechanisms Rating Scales-Self-Report-30. Three emerging personality profiles were identified. The emotionally dysregulated subtype, characterized by the strong
use of splitting, projective identification, acting, was positively related to angry/criticized and disorganized
therapist responses. The impulsive–histrionic subtype, characterized by disavowal and minor image-distorting defenses, acting, was positively related to angry/criticized and sexualized therapist responses. The dependent–victimized subtype, characterized by depressive defenses, was negatively related to overinvolved/
worried therapist response. A more differentiated view of BPD may have relevant treatment implications
and may help plan individualized and effective interventions in adolescence
I disturbi bipolari e depressivi
No full textIl capitolo approfondisce l'assessment dei disturbi bipolari e depressivi secondo il DSM-5-TR, l'ICD-11 e il PDM-
THERAPIST RESPONSES, PATIENT EMERGING PERSONALITY PATTERNS AND MENTALIZED AFFECTIVITY IN THE PSYCHOTHERAPY OF ADOLESCENTS WITH DEPRESSIVE DISORDERS
No full textThe assessment of depressive disorders is challenging in adolescence. This study explored the relationship
between patients’ personality patterns, mentalized affectivity, and the therapists’ responses in the treatment
of this clinical population. One hundred clinicians completed the Psychodiagnostic Chart-Adolescent of the
PDM-2 and the Therapist Response Questionnaire for Adolescents. Adolescent patients filled in the Mentalized Affectivity Scale. Four emerging personality profiles were identified: depressive/introjective, anxious–avoidant, emotionally dysregulated and narcissistic. Adolescents presenting with emotionally dysregulated, and narcissistic personality patterns show greater impairment in the mentalized affectivity and tend
to evoke in the therapist negative emotional reactions. Patients with depressive/introjective pattern show
better capacities in the mentalized affectivity domain and elicit less negative countertransference reactions.
The study extends knowledge on the personality patterns, mentalized affectivity and countertransference
reactions related to depressive disorders in adolescents. Therapists should use the information derived from
an accurate psychodynamic assessment to promote tailored treatments
Exploring the Outcomes of Psychotherapy Sessions: How do Therapists’ Responsiveness and Emotional Responses to Patients with Personality Disorders Affect the Depth of Elaboration?
No full textBackgroundThe impact of depth of elaboration in individual psychotherapy sessions on overall treatment effectiveness was found in the empirical literature. In the best sessions, relevant content is processed with greater depth; in contrast, in the shallower sessions, the emerging content is more superficial. Evidence suggests that achieving a high level of depth is closely related to specific therapist characteristics and relational dimensions (including clinicians' emotional responses to patients). The present study aimed to (a) compare therapist responsiveness and countertransference patterns in psychotherapy sessions with different levels of depth of elaboration; and (b) examine if the positive countertransference pattern mediated the relationship between therapist responsiveness and depth of elaboration.MethodsEighty-four clinicians were asked to select one patient with personality disorders in their care and complete the Depth Scale of the Session Evaluation Questionnaire, the Patient's Experience of Attunement and Responsiveness Scale, and the Therapist Response Questionnaire concerning one of their sessions.ResultsThe results showed that sessions with higher levels of depth of elaboration were characterized by greater therapist responsiveness and more positive countertransference. Conversely, poor therapist responsiveness and hostile/angry, disengaged, and helpless/inadequate countertransference responses were found in shallower sessions. Moreover, positive countertransference mediated the relationship between therapist responsiveness and depth of elaboration.ConclusionThis study sought to shed light on the processes underlying the outcomes of psychotherapeutic sessions, highlighting the strong impact of relational factors. Advancing knowledge of these mechanisms seems crucial to identifying the active ingredients of the therapeutic process and understanding what (does not) promote successful outcomes
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