Patient early session experience and treatment outcome.

Patient Session Evaluation Questionnaire (SEQ: Stiles, 1980) ratings from early in treatment were examined in relation to outcomes during psychodynamic psychotherapy. Twenty-eight therapists treated 73 patients at a university-based clinic. A relationship between Smoothness ratings and symptom improvement approached statistical significance using bivariate correlations and multilevel analyses.

Can positive social exchanges buffer the detrimental effects of negative social exchanges? Age and gender differences.

Background: Findings from existing research exploring whether positive social exchanges can help to offset (or 'buffer' against) the harmful effects of negative social exchanges on mental health have been inconsistent. This could be because the existing research is characterized by different approaches to studying various contexts of 'cross-domain' and 'within-domain' buffering, and/or because the nature of buffering effects varies according to sociodemographic characteristics that underlie different aspects of social network structure and function.

Objective: The purpose of this study was to examine whether the buffering effects of global perceptions of positive exchanges on the link between global negative exchanges and mental health varied as a function of age and gender.

Toward a multidimensional model of personality disorder diagnosis: implications for DSM-5.

This article outlines a model of personality disorder (PD) diagnosis that combines clinically useful constructs from the Diagnostic and Statistical Manual of Mental Disorders (DSM) with assessment procedures that maximize reliability and clinical utility while minimizing problems associated with threshold-based PD classification. I begin by addressing limitations in the current DSM conceptualization of PDs: excessive comorbidity, use of arbitrary cutoffs to distinguish normal from pathological functioning, failure to capture variations in the adaptive value of PD symptoms, and inattention to situational influences that shape PD-related behaviors. The revisions proposed by the DSM-5 Personality and Personality Disorders Work Group help resolve some of these issues, but create new problems in other areas.

Compulsive "helpfulness": or, how I learned to stop working so hard and love the group.

Compulsive helpfulness, an anxiety-laden need by the therapist to feel helpful, akin to the notion of rescuing others, is a potential pitfall in developing an effective psychotherapy group. It can be regarded variously: (1) as a reaction formation against feelings of boredom and frustration stimulated by such phenomena as group resistance or the enactment of inauthentic relationships in the group; (2) as a therapist style driven by a transferential reaction to be regarded as competent and worthy; (3) as an induced countertransference enactment tied to group members' frustration and passivity about their own interpersonal inadequacies; (4) and as a manic defense against despair over the feeling that one's loving has not done any good. In this essay, the author explores his struggle to identify and come to terms with compulsive helpfulness as a dominant theme in the early stages of his tenure as leader of a psychotherapy group.

Illuminating a neglected clinical issue: societal costs of interpersonal dependency and dependent personality disorder.

Objectives: To determine the degree to which patients with high levels of trait dependency or dependent personality disorder (DPD) engage in behaviors that harm themselves and others (e.g., domestic violence, child abuse).

From dysfunction to adaptation: an interactionist model of dependency.

Contrary to clinical lore, a dependent personality style is associated with active as well as passive behavior and may be adaptive in certain contexts (e.g., in fostering compliance with medical and psychotherapeutic treatment regimens).

Psychodynamic psychotherapy of ADHD: a review of the literature.

Contributions of psychodynamic psychotherapy to the treatment of children with attention deficit hyperactivity disorder (ADHD) have been sparse. However, mixed results of other interventions, including behavior therapy and medication, call for a systematic examination of psychodynamic contributions to treatment of ADHD children. A systematic review of the literature on psychodynamic psychotherapy with ADHD children yielded a combination of 23 case studies, research reports, and theoretical writings.

Rorschach score validation as a model for 21st-century personality assessment.

Recent conceptual and methodological innovations have led to new strategies for documenting the construct validity of test scores, including performance-based test scores. These strategies have the potential to generate more definitive evidence regarding the validity of scores derived from the Rorschach Inkblot Method (RIM) and help resolve some long-standing controversies regarding the clinical utility of the Rorschach. After discussing the unique challenges in studying the Rorschach and why research in this area is important given current trends in scientific and applied psychology, I offer 3 overarching principles to maximize the construct validity of RIM scores, arguing that (a) the method that provides RIM validation measures plays a key role in generating outcome predictions; (b) RIM variables should be linked with findings from neighboring subfields; and (c) rigorous RIM score validation includes both process-focused and outcome-focused assessments.

Therapeutic immediacy across long-term psychodynamic psychotherapy: an evidence-based case study.

C. E. Hill (2004) recently developed the concept of therapist immediacy to capture discussion by the therapist about the therapeutic relationship that occurs in the here-and-now of a therapy session.

The primal scene in cross-species and cross-cultural perspectives.

A review of cross-species and cross-cultural research suggests that, throughout most of human behavioral evolution, children may have been enlightened as to the facts of life by observing parental intercourse and then imitating it in sexual rehearsal play in the context of a continuously rising curve of sexual desire and sexual knowledge throughout childhood. Concealment of the primal scene and prohibition of cross-generational, bisexual, and 'polymorphously perverse' childhood sex play may be of relatively recent origin in human cultural evolution, buttressed by the instillation of culturally acquired sexual disgust in sexually conservative cultures. Looking at the primal scene in cross-species and cross-cultural perspectives utilizing the adaptationist framework of contemporary evolutionary biology can challenge normative assumptions that may still be embedded in psychoanalytic theories of species-wide psychosexual development.

Adaptive and Maladaptive Dependency in Bereavement: Distinguishing Prolonged and Resolved Grief Trajectories.

Interpersonal dependency is typically viewed as a risk factor for prolonged grief among conjugally bereaved adults. However, emerging empirical evidence and theoretical advances suggest that one manifestation of interpersonal dependency--adaptive dependency--may serve as a protective factor in coping with loss. This study compared adaptive and maladaptive dependency across three matched groups: prolonged grievers, asymptomatically bereaved adults, and a married comparison group.

Toward a process-focused model of test score validity: improving psychological assessment in science and practice.

Although definitions of validity have evolved considerably since L. J. Cronbach and P.

Evaluating psychological insight in a clinical sample using the Shedler-Westen assessment procedure.

Using the Shedler-Westen Assessment Procedure (SWAP)-200 Q-Sort items in a large clinical sample of outpatients (N = 105), we developed the SWAP insight scale. The rationale, psychometric properties, and convergent validity of this insight scale are reported. Through factor analysis, six of the SWAP-200 items were identified as psychometrically optimal in the assessment of insight (presence or absence) with an alpha coefficient of 0.

Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes.

The DSM-5 Personality and Personality Disorders Workgroup proposed that five DSM-IV personality disorders be eliminated as formal diagnostic categories (paranoid, schizoid, histrionic, narcissistic, and dependent), because these syndromes purportedly have low clinical utility and minimal evidence for validity. Scrutiny of studies cited in support of this proposal reveals difficulties in three areas: (1) Inadequate information regarding parameters of the literature search; (2) Mixed empirical support for proposed changes; and (3) Selective attention to certain disorders and not others. Review of validity and clinical utility data related to dependent personality disorder indicates that evidence regarding this syndrome does not differ from that of syndromes proposed for retention in DSM-5.

From symptom to process: how the PDM alters goals and strategies in psychological assessment.

In many respects the Psychodynamic Diagnostic Manual (PDM) P and M Axes represent psychoanalytic versions of Diagnostic and Statistical Manual of Mental Disorders (DSM) Axes II and V: Whereas the DSM axes focus on surface behaviors and their associated mental states (e.g., thought patterns, affective responses), the PDM axes emphasize underlying psychodynamic processes (e.

Associations between menarcheal timing and behavioral developmental trajectories for girls from age 6 to age 15.

Substantial evidence from cross-sectional and short time-span longitudinal studies exists about negative associations between early pubertal maturation on a number of psychological outcomes. The objective of the present study was to assess the association between early maturation and developmental trajectories of social skills and internalizing and externalizing problems in girls from grades 1 through 9, including pre- and post-pubertal periods. The sample came from the NICHD Study of Early Child Care and Youth Development and included 398 Caucasian and 60 African American girls.

Should I stay or should I go? Personality Assessment Inventory and Rorschach indices of early withdrawal from psychotherapy.

The Personality Assessment Inventory (PAI) and the Rorschach were used to investigate differences between patients who withdrew early from university-based outpatient psychodynamic psychotherapy and those who continued in treatment. The study employs two sets of analyses, one utilizing the complete sample (N = 101) and a second comprised of comparison pairs matched on the specific therapist delivering treatment (n = 36 for Rorschach; n = 38 for PAI). It was hypothesized that early withdrawers would score higher on the PAI Treatment Rejection Scale (RXR) and the PAI Treatment Process Index (TPI) than treatment continuers.

The evolved function of the oedipal conflict.

Freud based his oedipal theory on three clinical observations of adult romantic relationships: (1) Adults tend to split love and lust; (2) There tend to be sex differences in the ways that men and women split love and lust; (3) Adult romantic relationships are unconsciously structured by the dynamics of love triangles in which dramas of seduction and betrayal unfold. Freud believed that these aspects of adult romantic relationships were derivative expressions of a childhood oedipal conflict that has been repressed. Recent research conducted by evolutionary psychologists supports many of Freud's original observations and suggests that Freud's oedipal conflict may have evolved as a sexually selected adaptation for reproductive advantage.

The rocky road from Axis I to Axis II: extending the network model of diagnostic comorbidity to personality pathology.

Although the network model represents a promising new approach to conceptualizing comorbidity in psychiatric diagnosis, the model applies most directly to Axis I symptom disorders; the degree to which the model generalizes to Axis II disorders remains open to question. This commentary addresses that issue, discussing opportunities and challenges in applying the network model to DSM-diagnosed personality pathology.

The co-evolution of sexual desire, narcissistic vulnerability, and adaptations for reproductive advantage.

According to evolutionary psychologists humans possess a variety of "sexual ornaments," physical as well as psychological traits that have evolved as adaptations for reproductive advantage. These sexual ornaments serve as sexually selected indicators of fitness that are automatically assessed, inspire attentional adhesion, and evoke sexual desire in those searching for a mate. Mate choice is therefore determined by the relative presence or absence of these sexually selected indicators of fitness in comparison to the competition.

Interpersonal dependency in borderline personality disorder: clinical context and empirical evidence.

Personality theorists and practicing clinicians agree that high levels of interpersonal dependency play a role in Borderline Personality Disorder (BPD), and this link has been codified in several editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although there is widespread agreement that dependency is linked to BPD, there has never been a systematic review of empirical evidence bearing on this issue. This article reviews research in three areas: (1) the comorbidity of Dependent Personality Disorder (DPD) and BPD; (2) the association between trait dependency and BPD; and (3) differences in free-response (i.

Construct validity of the relationship profile test: correlates of overdependence, detachment, and healthy dependency in low income urban women seeking medical services.

Studies have documented the construct validity of Bornstein and Languirand's (2003) Relationship Profile Test (RPT) in college students, psychotherapy patients, and nursing home residents, but no studies have examined the utility of RPT Destructive Overdependence (DO), Dysfunctional Detachment (DD), and Healthy Dependency (HD) scores in community samples. To fill this gap, we assessed links between RPT scores and theoretically related variables in low income urban women seeking medical services (N = 110), obtaining predicted links between RPT scores and scores on measures of childhood abuse and neglect, adult attachment style, conflict-resolution tactics involving a domestic partner, Axis I symptomatology, and overall quality of life. Comparison of RPT means in this sample with those in Bornstein et al.

Patient and therapist perspectives on session depth in relation to technique during psychodynamic psychotherapy.

This study investigates the relationship between therapist techniques with patient and therapist ratings of session Depth (powerful, valuable, deep, full, and special). Eighty-three patients were admitted to a university-based community outpatient psychological clinic, and videotapes of an early treatment session were reliably rated by trained coders to identify techniques used by therapists. Overall amount of psychodynamic-interpersonal technique was found to have a significant positive correlation with patient-rated session Depth, and a trend toward significance was observed with therapist-rated session Depth.

Convergent validity of the SWAP-200 dependency scales.

The present study examined the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort (SWAP-200; ) dependency scales (Dependent Personality Disorder [DPD] Clinical Prototype and DPD composite description) by examining links between these variables with Inventory of Interpersonal Problems Circumplex Scales (IIP-C; Alden et al., 1990; Horowitz et al., 2000; Horowitz et al.