Psychoanalysis with avoidant personality disorder: A systematic case study.

This case study of process and outcome is based upon data obtained during a 5-year psychoanalysis of an adult male with avoidant personality disorder (AVPD). To date, no known systematic case studies, effectiveness studies, or randomized control trials exist for psychoanalysis in the treatment of AVPD. In this study, self-reported symptoms and observer-rated personality disorder (PD), global functioning, object relations, and psychological health were gathered at intake, after each year of treatment, and at 1-year follow-up. Process data was gathered to determine the extent to which the treatment adhered to prototypes of psychodynamic, cognitive-behavioral, and interpersonal therapy. Results indicated that the patient achieved clinically significant reductions in PD, symptom severity, and relational pathology. Gains were maintained at 1-year follow-up. The treatment significantly adhered to psychodynamic principles throughout, with some use of cognitive-behavioral and interpersonal principles in the third year of treatment. These findings warrant further investigation of psychoanalysis for AVPD and demonstrate the usefulness of assessing multiple domains of patient functioning and treatment process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiple personality disorder: Etiology, treatment, and treatment techniques from a psychodynamic perspective.

Academic psychologists have moved away from psychoanalytic and psychodynamic explanations of human functioning and pathology and have instead embraced neuropsychology and cognitive science. This trend has kept many psychologists and researchers from more fully understanding some of the important phenomena they chose to investigate. One area about which psychologists can learn in the psychodynamic literature is multiple personality disorder (MPD). A thorough knowledge of the psychodynamic perspective with regards to MPD is important to all those in psychology who deal with MPD patients or who study the phenomenon. By understanding the abuse most of these patients suffered and the resulting impact this has had on their personality development, psychologists can begin to create effective and promising assessment tools and intervention programs. In this article, I review MPD and its treatment from a psychodynamic perspective in hopes that those in psychology (researchers and clinicians alike) may benefit from such a discussion and will utilize this information in their attempts to understand MPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Personality styles and brief psychotherapy.

Reviews the book, Personality styles and brief psychotherapy by Mardi Horowitz, Charles Marmar, Janice Krupnick, Nancy Wilner, Nancy Kaltreider, and Robert Wallerstein (1984). This book by Horowitz and his colleagues falls in the category of psychodynamic psychotherapy, and in fact lies very close to the heart of traditional, but updated, forms of psychoanalytic psychotherapy. Clinicians who have attempted to master ego-analytic psychotherapy will recognize key concepts in this book that are germane to traditional therapy. These include: stressful events that precipitate psychopathology in specific personality types; the concept of wish, defense, and the dynamic compromise behavior/attitude; patterns of defensive organization and cognitive style typical of personality types; therapeutic tactics related to those personality patterns; and the triad of insight-transference relationship, current relationships, and parental relationships. Horowitz's book has value for a number of overlapping purposes. It should be included in a course on short-term therapy, it is an up-to-date and sophisticated review of personality theory, it is important in the empirical refining of psychodynamic technique, short- or long-term, and it is essential for an understanding of how psychotherapy research is indeed beginning to have a significant impact on psychotherapy theory and technique. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Personology: Method and content in personality assessment and psychobiography.

Reviews the book, Personology: Method and content in personality assessment and psychobiography by Irving E. Alexander (see record 1990-97879-000). The subtitle accurately specifies the scope of this volume, and the title, Personology, identifies the book with the tradition of Henry A. Murray and the Harvard Psychological Clinic, which focused on idiographic, holistic, psychodynamic personality assessment. The book is relevant to modern psychoanalysis in two distinct ways. On one hand, it attempts, with unusual success, to systematize the principles of psychodynamic interpretation that are common to many versions of psychoanalysis ("method" in "personality assessment," in the book's title). On the other hand, it applies these principles to illuminate salient ways in which the inner lives of major contributors to psychoanalytic theory (Freud, Jung, and Sullivan) may have shaped their theoretical contributions (i.e., "content" and "psychobiography" in the title). The psychobiographical chapters should fascinate readers already familiar with biographical studies of these Olympian innovators, and because of the general familiarity of the terrain, the chapters serve very well the didactic purpose of illustrating how personological inference is done. Recent polemics have made much of the hermeneutic approach to human psychology, as alternative to scientistic positivism, but not very much is being written on how to do hermeneutics, and little has been produced to show that it is worth doing. Personology is therefore a rare contribution that deserves to be widely read and pondered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity.

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Some effects of information, situation, and personality on decision making in a clinical setting.

40 graduate students were used as Ss to investigate some relationships among informational, situational, and personality variables and to observe the effects of these variables on various aspects of interpretive decision behavior. The major finding was that high-anal Ss (on the Dynamic Personality Inventory) have less confidence in their interpretations, make fewer specific predictions, and find less pathology in their patients than low-anal Ss. This finding confirms some aspects of the psychoanalytic view of personality and points out that clinical decisions are not independent of the clinician's personality. The effects of ego involvement and different conditions of information on clinical decision making were also investigated. Clear-cut implications about these variables cannot be derived from this study, although some suggestions about the relationship of ego involvement to personality and defense are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do personality problems improve during psychodynamic supportive–expressive psychotherapy? Secondary outcome results from a randomized controlled trial for psychiatric outpatients with personality disorders.

Studies involving patients with personality disorders (PDs) have not focused on improvement of core aspects of the PD. The authors examined changes in quality of object relations, interpersonal problems, psychological mindedness, and personality traits in a sample of 156 patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PD diagnoses being randomized to either manualized or nonmanualized dynamic psychotherapy. Effect sizes adjusted for symptomatic change and reliable change indices were calculated. The authors found that both treatments were equally effective at reducing personality pathology. Only in neuroticism did the nonmanualized group do better during the follow-up period. The largest improvement was found in quality of object relations. For the remaining variables, only small and clinically insignificant magnitudes of change were found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Validity of the Five-Factor Model Prototypes for Personality Disorders in Two Clinical Samples.

The authors examined the validity of D. R. Lynam and T. A. Widiger's (2001) prototypes for personality disorders (PDs) derived from the facets of the 5-factor model (FFM) of personality in 2 clinical samples. In the 1st sample (N = 94), there was good agreement between the prototypes generated by experts and the profiles reported by patients. These FFM PD similarity scores also demonstrated good convergent and discriminant validity with results from a semistructured interview and a self-report measure of Axis II pathology. In the 2nd sample (N = 132), the FFM PD similarity scores demonstrated excellent longitudinal stability and good predictive validity with regard to consensus ratings of PD features. The implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorder symptoms and marital functioning.

Pathological personality is strongly linked with interpersonal impairment, yet no study to date has examined the relationship between concurrent personality pathology and dysfunction in marriage--a relationship that most people find central to their lives. In a cross-sectional study of a community sample of married couples (N = 82), the authors used multilevel modeling to estimate the association of self- and spouse-reported symptoms of personality disorder (PD) with levels of marital satisfaction and verbal aggression and perpetration of physical violence. Inclusion of self- and spouse report of total PD symptoms resulted in improved model fit and greater variance explained, with much of the improvement coming after the addition of spouse report. The incremental validity of spouse report for several of the 10 PD scales was supported for marital satisfaction and verbal aggression, particularly for the Borderline and Dependent PD scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Action and insight.

Reviews the book, Action and insight by Paul L. Wachtel (see record 1988-97486-000). Action and insight is a compendium of Paul Wachtel's most important papers. Wachtel's capacity to move from personality theory to clinical theory to clinical technique, with each informing the others, is probably unequaled by any other contemporary psychologist. His reflections on personality are in noteworthy contrast to so much contemporary work in personality psychology. Wachtel begins the book with a series of chapters on theory, in which he challenges several aspects of psychodynamic thinking, and lays out his theory of "cyclical psychodynamics." Wachtel also challenges the "motivational omnipotence" of psychoanalytic theory, which underemphasizes cognitive and situational determinants of behavior. Wachtel's suggestions for clinical technique flow organically from his theoretical position. If the cornerstone of a theory of psychopathology is repression--not knowing--then the cornerstone of treatment must be insight--knowing. If, however, another cornerstone of the theory is anxiety, then action and insight become intertwined, and a more active intervention style may be necessary. Action and insight is a cogent, sophisticated, clearly written book that challenges clinicians from every point of view. This is integrative work at its best. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychodynamic play therapy with a high-functioning autistic child.

The increasingly dominant and sound view of autism as a developmental disorder has led to adoption of highly structured behavioral interventions and abandonment of psychoanalytic approaches. This article intends to reaffirm the relevance of traditional psychodynamic play therapy to the milder variants of the autistic syndrome. The therapy process with one high-functioning autistic child is examined and discussed in the context of autistic pathology and psychodynamic theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcissism in two forms: Implications for the practicing psychoanalyst.

There has been a great deal of controversy expressed in the recent psychoanalytic literature as to the etiology and treatment of patients with narcissistic personality disorders. The most intense disagreement has been centered around the largely contradictory theories of Heinz Kohut and Otto Kernberg. The clinically important distinctions between these two theories are outlined in this article. They include the differential importance each theory places on aggression in the etiology of narcissism and resistance in the treatment of narcissistic patients. A basic difference between these theories is the model they adopt for the understanding of the development of narcissistic pathology generally; with Kohut advocating a developmental arrest point of view, and Kernberg advancing a theory more consistent with classical psychoanalysis, that of an instinctual or structural conflict. This article contends that the understanding of the narcissistic patient can be greatly aided by recognizing that each of these theories correctly assesses and treats a specific form of narcissistic pathology. Clinical data from the psychoanalytic treatments of two narcissistic patients are presented. As is indicated by this clinical material, cues that the practicing psychonalyst can employ in making... (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reconnecting psychoanalysis to mainstream psychology. Challenges and opportunities.

Although psychoanalysis was once central to mainstream psychology, in recent years psychodynamic models of personality and psychopathology have become increasingly marginalized. The factors that combined to "disconnect" psychoanalysis from contemporary psychological science and clinical practice are examined, and strategies that can help reconnect psychoanalysis to mainstream psychology are described. These are (a) the use of nomothetic research methods to test and refine psychoanalytic concepts and (b) the communication of psychoanalytic principles and findings to colleagues, students, and members of the public. Opportunities and challenges that arise during this reconnection process are discussed, and prospects for the rebirth of a truly heuristic, integrative psychoanalysis are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline pathology: An integration of cognitive therapy and psychodynamic therapy.

Because of the belated interest in borderline pathology outside of the psychoanalytic arena, there is a relative paucity of integrative models for the treatment and understanding of borderline pathology. This article compares and contrasts the practice of A. T. Beck and A. Freeman's (1990) cognitive treatment of borderline pathology with 0. F. Kernberg's (Kernberg, Selzer, Koenigsberg, Carr, & Appelbaum, 1989) psychodynamic approach. An integrative model of borderline pathology is proposed, building on Beck and Freeman's and Kernberg's shared use of the notion of schema-representation. The practice implications of the proposed integrative model are consequently entertained. A brief case study is provided to illustrate the integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The undisordered personality: Normative assumptions underlying personality disorder diagnoses.

Clinical diagnoses are impossible without referring to normative assumptions about what is desirable functioning. In this paper, the authors explicate the implicit normative assumptions that seem to have guided the formulation of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) personality disorder (PD) criteria. Then the authors discuss various conceptual reference frames in which such assumptions may be grounded: (1) a given diagnostician’s personal value system, (2) the expectations of the culture in which a person currently lives, (3) the expectations of the culture in which a person was raised, (4) models of “natural” personality functioning that are rooted in evolution theory, and (5) the presence of distress and/or impairment. In accordance with Wakefield (1992a, 2006), the authors argue that PD diagnoses necessarily involve both an evolutionary and a cultural component. If PDs were defined completely in cultural terms, investigating their biological underpinnings would be nonsensical. In addition, the values of any specific culture should not be given too much weight, because cultural expectations may themselves be harmful. Future editions of DSM should define personality pathology in less culture-relative terms, and address the inevitable issue of values more explicitly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Tale of Two Visions: Can a New View of Personality Help Integrate Psychology?

Personality psychology studies how psychological systems work together. Consequently, the field can act as a unifying resource for the broader discipline of psychology. Yet personality's current fieldwide organization promotes a fragmented view of the person, seen through such competing theories as the psychodynamic, trait, and humanistic. There exists an alternative--a systems framework for personality--that focuses on 4 topics: identifying personality, personality's parts, its organization, and its development. This new framework and its view of personality are described. The framework is applied to such issues as personality measurement, psychotherapy outcome research, and education. The new framework may better organize the field of personality and help with its mission of addressing how major psychological systems interrelate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An abilities conception of personality: Some implications for personality measurement.

Most "psychologists have tended to regard the domains of personality and ability as separate. This unfortunate separation has resulted in a necessary confounding of 2 important response properties in personality research, i.e., response predisposition and response capability… . In the measurement of abilities, attempts are made to elicit indices of maximal performance under optimal conditions of measurement." On the other hand, personality tests based on "psychoanalytic notions of projection would imply the more ambiguity the better." Predisposition conceptions of personality "can lead to operations which are clearly at odds with those demanded by an abilities conception." From an abilities conception, "the usefulness of any measuring instrument would decrease as ambiguity in the measuring instrument is increased." The choice, to search for man "as he really is" or in terms of those things "of which he is capable" is of utmost importance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Shedler-Westen Assessment Procedure-200 as a basis for modifying DSM personality disorder categories.

The Shedler-Westen Assessment Procedure-200 (SWAP) is a Q-sort instrument designed to assess personality pathology on the basis of clinician ratings. On the basis of research with the SWAP, its creators have proposed a group of 12 personality disorder (PD) diagnoses that can be used to replace or modify current Axis II categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The authors discuss conceptual and empirical issues that require clarification before this proposal can be properly evaluated. They identify problematic psychometric features of the SWAP, including its unrepresentative normative sample, its reliance on a fixed skewed distribution, and anomalies in its T-score approach to diagnoses. In addition, a review of research on SWAP-based PD categories indicates that important information regarding diagnostic coverage, validity, and temporal stability is presently lacking. The authors conclude that research evidence is currently insufficient to justify the use of SWAP-based PD categories to guide revision of the DSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trainee theoretical orientation: Profiles and potential predictors.

The goal of this study was to provide data on the theoretical orientations of a sample of therapists in-training, as well as to investigate constructs that may help to predict identification with a particular theoretical orientation(s). Data on therapist theoretical orientation and personality were gathered from 46 graduate student therapists in 4 APA accredited clinical and counseling psychology programs. Although psychodynamic therapy was the most strongly endorsed single theoretical framework across the sample, the orientation with the highest mean rating was an eclectic/integrative approach. A 2-step cluster analysis was used to create orientation profiles to further explore psychotherapy integration, which produced a 3-cluster solution: (a) humanistic/systems/psychodynamic, (b) psychodynamic, and (c) cognitive–behavioral. A significant main effect for cluster membership and personality factors was found, and a chi-square analysis indicated differential representation across the three “integration clusters” as a function of training program. Implications for psychotherapy integration and training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)