Interactional and intrapsychic dynamics in a family with a borderline patient.

Proposes an integration of intrapsychic with interpersonal theory in explaining borderline behavior in the family. It is asserted that borderline patients use the primitive ego defenses of projective identification, splitting, and idealization to resolve their intrapsychic problems through interpersonal means. Behaviors or symptoms resulting from the employment of these defenses can be observed in family interactions. References to those behavior manifestations are presented from the family therapy literature, and the case of a family is used to illustrate family and intrapsychic dynamics. It is hypothesized that family therapy is a useful alternative for treating the borderline patient because the family is the primary structure in which borderline behavior is encouraged and maintained. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incest and the borderline syndrome: The mediating role of identity.

This article reviews psychoanalytic theory, clinical studies, and empirical investigations regarding the pathological effects of father-daughter incest. This literature suggests strong links between childhood incest and serious psychopathological sequelae, particularly borderline personality disorder. I propose a model for understanding the impact of incest, using the concept of identity as a mediating construct. Particular emphasis is placed on the role played by incest in the disruption of the developing boundary between internal and external reality. Such defects may result in the failure of age-appropriate divestment of the illusion of omnipotent control and the inappropriate persistence of efforts to control others. Thus, such disruptions may account for major aspects of borderline syndrome including identity diffusion, affective instability, and primitive defenses. A case vignette is presented as an illustration of the model's cogency with respect to the treatment of a borderline incest victim. Theoretical, treatment, and research implications are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Inventory of Personality Organization: Psychometric properties, factorial composition, and criterion relations with affect, aggressive dyscontrol, psychosis proneness, and self-domains in a nonclinical sample.

This report describes 2 studies of the psychometric characteristics of the primary clinical scales of the Inventory of Personality Organization (IPO; O. F. Kernberg and J. F. Clarkin, 1995), which assess reality testing, primitive psychological defenses, and identity diffusion, in a nonclinical sample. The 3 IPO scales display adequate internal consistency and good test-retest reliability. Item-level confirmatory factor analysis supported a two-factor structure of the EPO consistent with O. F. Kemberg's (1984, 1996) model of borderline personality organization. Each of the 3 EPO scales was associated with increased negative affect, aggressive dyscontrol, and dysphoria as well as lower levels of positive affect consistent with Kernberg's model of borderline personality organization. The IPO Reality Testing scale is closely related to various measures of psychotic-like phenomena, (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When the therapist needs therapy: Characterological countertransference issues and failures in the treatment of the borderline personality disorder.

Addresses a number of defenses and identity issues presented by the borderline patient that assault the ego boundaries and limits of the therapist and that encourage the therapist to act out his or her denied or unresolved identity issues with the patient. The primary defenses that will be discussed are splitting, primitive idealization, projection, projective identification, denial, omnipotence, and devaluation. The primary identity issues to be addressed in both the patient and the therapist are a split self rather than a sense of a real self, ego identity disturbances and ego deficits, boundary and limits difficulties, and the superego demand of perfection with accompanying despair, guilt, anger, and shame. Recommendations are made to enable therapists to more effectively address these issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social perceptions and borderline personality disorder: The relation to mood disorders.

Used the Structural Analysis of Social Behavior to compare the social perceptions of borderline, unipolar, and bipolar-depressed inpatients. As predicted, borderline Ss differed from bipolar-depressed and unipolar Ss in their social perceptions. Borderline Ss viewed their relationships to their mother, hospital staff, and other patients as more hostile and autonomous than did mood disordered Ss. The results are discussed in terms of an integrative theory of borderline personality that considers the psychobiology of interpersonal relationships and attachment disruptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding and treating borderline personality organization.

For many years, clinicians have been puzzled by those nonpsychotic but severely disturbed patients referred to as borderline. Recent work in object-relations theory has suggested that borderline conditions are the result of a failure of integration of the basic personality, leading to a major distortion in the patient's sense of self. Because most of this investigative work is relatively recent, many clinicians are unfamiliar with current theory and clinical observations on the subject. Failure to comprehend these patients' dynamics can lead to treatment catastrophes, whereas understanding of these phenomena may be helpful in dealing with a wide variety of borderline and other clinical problems. The authors present an overview of borderline dynamics and a discussion of 3 major sequelae of these patients' distorted sense of self: "as-if" phenomenon, diffuse sexual identity, and overwhelming aloneness. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Psychotherapy of the disorders of the self: The Masterson approach.

Reviews the book, Psychotherapy of the disorders of the self: The Masterson approach, edited by James F. Masterson and Ralph Klein (see record 1988-98808-000). The senior editor of this text reminds us that the DSM-IIIR is an insufficient guide to appropriate diagnosis of personality disorders. As Masterson indicates, it is highly questionable that the borderline disorders can be distilled to a single "borderline personality disorder" rather than a range of conditions emerging from separation-individuation developmental crises and maternal libidinal unavailability. Masterson assists us in integrating borderline conditions by enabling an understanding of the defenses against abandonment depression that manifest in these patients. Klein, in turn, adds an invaluable dimension to differential diagnosis in his reminder that a diagnostic picture is incomplete when it fails to integrate the current ego functions and impairments and the nuances of the family, along with their developmental and medical history. This volume is well suited not only for the seasoned clinician who has experienced the full impact of character pathology in clinical practice but also for the student whose understanding of personality disorders is often restricted to the limited role provided by our current diagnostic manual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of assertive community treatment on the social relationships of people who are homeless and mentally ill

Two randomized experiments compared the effectiveness of the assertive community treatment (ACT) team against other treatments (outpatient therapy, drop-in center, and brokered case management) in improving the social relationships of individuals who were both homeless and suffered from severe and persistent mental illness. In both studies clients assigned to ACT teams reported having more professionals in their social networks than clients assigned to the other treatments. Clients did not report significant differences between treatment conditions on most of the other social relationship dimensions. Further attention to developing social skills and network interventions within ACT teams are recommended.     

Prestage versus defensive splitting and the borderline personality: A Rorschach analysis.

This paper reviews theoretical contributions by Kernberg (1975) and by Stolorow and Lachmann (1980) regarding defensive modes of splitting and suggests possible Rorschach manifestations for a variety of levels of defensive organization among borderline patients. Defensive operations vary among patients with different levels of severity of borderline psychopathology. Specifically, it is proposed that some borderline patients rely on splitting as an active attempt to mitigate the experience of intense ambivalence conflicts toward others, as described by Kernberg; another group of borderline patients is seen as having pathology that revolves around a weakly integrated representational world, poor self-object differentiation, and prestage developmental levels of defense, as described by Stolorow and Lachmann. The Rorschach is a valuable diagnostic tool in distinguishing between psychopathology involving defenses against structural conflict and psychopathology based on an arrest in development at the level of prestage defensive operations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnoanalysis--with particular emphasis on the borderline patient.

In the first part of this paper a short overview of the history of hypnotherapy and hypnoanalysis, is given. Within the modality of hypnosis, the patient can make contact with his unconscious much faster than in the waking state. Primary process thinking and vivid imagery play a great role. Hypnotic imagery and the hypnotic state per se are "royal roads to the unconscious" on which the hypnoanalyst must attempt to walk with care but also with confidence, so that defenses are not pierced prematurely and the patient can learn to use to the fullest extent his innate healthy coping potential. The second part of the paper deals with the newest development in the field of hypnoanalysis, the treatment of the borderline patient with specialized hypnotic imagery techniques that have been found to help such patients overcome splitting, achieve object constancy, and good internalized object and self representations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primative anxiety and countertransference engagement.

Psychoanalytic theorists have described primitive anxieties, including disintegrative fears about annihilation, identity loss, and the emergence of psychosis, as a foundation for borderline and psychotic mental states. These destabilizing anxieties occur across the dimensional spectrum of health and psychopathology. Openness to participatory countertransference involves both analyst and patient in primitive anxieties through their diminished psychic boundaries and their immersion in each other's internal world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disputing the effects of championship pressures and home audiences.

New data led B. R. Schlenker, S. T. Phillips, K. A. Boniecki, and D. R. Schlenker (see record 1995-27389-001) to question whether home teams perform unusually badly (choke) when on the verge of winning a championship. Despite the new data, their main findings did not differ significantly from previous work that supported the "home-choke" hypothesis; they merely found that the effect dropped below significance. Their new data were confounded by a rule change favoring home teams. Their analysis omitted many games in which home teams apparently choked and lost. Also, their null findings did not justify strong conclusions. On the positive side, their new data on timing of errors did shed new light on and suggest modifications of previous theory. Implications regarding archival research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adaptive mental mechanisms: Their role in a positive psychology.

Psychology needs a metric for positive mental health that would be analogous to the IQ tests that measure above average intelligence. The Defensive Function Scale of the DSM-IV offers a possible such metric. In the present article the author links the transformational qualities of defenses at the mature end of the Defensive Function Scale (altruism, suppression, humor, anticipation, and sublimation) to positive psychology. First, the methodological problems involved in the reliable assessment of defenses are acknowledged. Next, the use of prospective longitudinal study to overcome such difficulties and to provide more reliable definition and measurement of defenses is outlined. Evidence is also offered that, unlike many psychological measures, the maturity of defenses is quite independent of social class, education, and IQ. Last, evidence is offered to illustrate the validity of mature defenses and their contribution to positive psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Object relations development and psychotherapy dropout in borderline outpatients.

Used Rorschach object relations measures to identify patterns of object representations in borderline outpatients that would distinguish those at risk for premature termination from those likely to continue in expressive psychodynamic psychotherapy. Existing data from the Borderline Psychotherapy Research Project (O. Kernberg et al, 1989) were used. Ss were 12 women, aged 21–39 yrs, with borderline personality disorder. Ss who dropped out showed a predominance of narcissistic themes in their Rorschach responses at the outset of treatment, as scored by the Rorschach Separation-Individuation Scale (S-I Scale), and produced almost 4 times as many narcissism as rapprochement themes on the S-I Scale as Ss who continued treatment. Overall findings lend support to the salience of developmental themes related to separation-individuation within the population of borderline patients. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Basic emotions, relations among emotions, and emotion-cognition relations.

From the cognitive theory perspective that emotions are cognition dependent and contain cognitive components, A. Ortony and T. J. Turner (see record 1990-27526-001) questioned the validity of the concept of basic emotions. They argued that the so-called basic emotions were neither psychologically or biologically "primitive" nor "irreducible building blocks" for generating the "great variety of emotional experiences." In the biosocial theory tradition, researchers have identified multiple noncognitive activators of emotion and demonstrated the usefulness of defining the essential components of emotion as phenomena that do not require cognitive mediators or constituents. In this framework, emotions are seen as basic because their biological and social functions are essential in evolution and adaptation. Particular emotions are called basic because they are assumed to have innate neural substrates, innate and universal expressions, and unique feeling–motivational states. The great variety of emotional experiences is explained as a function of emotion–cognition interactions that result in affective–cognitive structures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing a theory of the strategic core of teams: A role composition model of team performance.

Although numerous models of team performance have been articulated over the past 20 years, these models have primarily focused on the individual attribute approach to team composition. The authors utilized a role composition approach, which investigates how the characteristics of a set of role holders impact team effectiveness, to develop a theory of the strategic core of teams. Their theory suggests that certain team roles are most important for team performance and that the characteristics of the role holders in the "core" of the team are more important for overall team performance. This theory was tested in 778 teams drawn from 29 years of major league baseball (1974'-2002). Results demonstrate that although high levels of experience and job-related skill are important predictors of team performance, the relationships between these constructs and team performance are significantly stronger when the characteristics are possessed by core role holders (as opposed to non-core role holders). Further, teams that invest more of their financial resources in these core roles are able to leverage such investments into significantly improved performance. These results have implications for team composition models, as they suggest a new method for considering individual contributions to a team's success that shifts the focus onto core roles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Milieu countertransference in treatment of borderline patients.

Describes milieu countertransference as a collective phenomenon in which the treatment staff as a group experiences regressions in functioning that, because of the operation of the patient's ego defenses, essentially mirror the level of functioning in the patient. When properly identified and treated, the milieu countertransference can benefit treatment both as a means to better understand the patient's experience and as a tool for active intervention in remediation of the patient's pathological development. A case report, involving a 14-yr-old male, is presented to illustrate the issues and interventions involved in the milieu countertransference developed in the treatment of a borderline patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The patient's search for safety: The organizing principle in psychotherapy.

This article presents the Control-Mastery view that patients organize the process of their psychotherapy in their search for psychological safety with the therapist. According to this theory, people unconsciously assess their social environments for signals of safety and danger, relaxing their defenses when it seems safe to do so. In therapy, patients test to find the safety with the therapist which would free them to be less defensive in that relationship and, ultimately, in all their relationships. Understanding how patients' activity in psychotherapy is organized by their search for safety can simplify the treatment process for the therapist and help to guide the therapist's interventions. Clinical examples are used to illustrate these ideas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the self-concept and the social context in determining the behavior of power holders: Self-construal in intergroup versus dyadic dispute resolution negotiations.

In this work, the authors explored how a person's view of himself or herself might determine his or her use of power in a complex dispute resolution negotiation. In 3 studies of asymmetric power in negotiations, the authors demonstrated that the impact of power on motivation and behavior is moderated by both a person's self-view and the social context. In Study 1, the results revealed that in a one-on-one dispute, powerful individuals primed to hold an interdependent (as opposed to independent) self-construal are more generous in resolving their disputes with low-powered opponents. Study 2 replicated this finding but revealed a different pattern in intergroup disputes, in which powerful interdependent teams of negotiators are actually less generous than are independent teams. Study 3 provided a conceptual replication of Study 2, with the use of chronic measures of self-construal and self-reported measures of behavior. Results suggest that an interdependent self-construal may lead to a more benevolent use of power in dyadic conflicts but more exploitive uses of power in intergroup conflicts. Implications for the understanding of power and self-construal are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shorter term treatment of borderline personality disorder: A developmental, self-, and object relations approach.

After a brief summary of J. F Masterson's developmental, self-, and object relations approach to long-term, intensive psychotherapy of the borderline personality disorder, an adaptation of this approach to shorter term treatment is proposed. The time constraints of abbreviated treatment require the following limited goals for the patient: (a) increased control of maladaptive defenses, (b) learning about the fundamental dynamics related to the focal symptom or problematic behavior, and (c) improved adaptation. Requisite modifications of technique include (a) limited frequency of sessions, (b) focalized treatment, (c) an emphasis on adaptation, and (d) a reliance on confrontation as the primary therapeutic intervention. A brief case study is presented for illustrative purposes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)