Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy

The Inventory of Interpersonal Problems (IIP) has been used to identify dysfunctional patterns in interpersonal interactions. Interpersonal problems can be organized in two dimensions, and the two-dimensional space can be divided into eight equal sectors (octants). Subscales of the IIP describe each of these octants. The instrument has been used to identify (a) interpersonal problems that are discussed most often in a brief dynamic psychotherapy and (b) problems that are treated most easily. The results show that problems in the "exploitable" octant improve most frequently, whereas problems in the "dominating," "vindictive," and "cold" octants do not improve as readily. Attachment styles in adulthood were examined (following a model proposed by Bowlby), and different attachment styles were found to correspond to different types of interpersonal problems. Finally, these variables were related to the ability to describe other people clearly. The article also discusses implications for brief dynamic psychotherapy.     

Sex differences in interpersonal problems: A circumplex analysis.

The structure and magnitude of sex differences in interpersonal problems across several data sets were examined, guided by the interpersonal circumplex model and the structural summary method. Data were self-reported interpersonal difficulties, assessed with the 64-item version of the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, S. E. Rosenberg, B. A. Baer, G. Ure?o, & V. S. Villase?or, 1988). In Study 1, the authors focused on sex differences at the level of specific interpersonal complaints (item level). In Study 2, the authors examined sex differences in octant scores of the IIP circumplex (scale level), in a reanalysis of archival data. The structural summary method was used to identify points of maximum difference between men and women in the interpersonal continuum and to estimate effect sizes. Results from the 2 studies converged in suggesting a dimension of difference involving problems in Hostile-Dominance vs. Friendly-Submission. The magnitude of effect size was consistent with previous reports in the personality literature. These sex differences appeared to be best explained by a one-dimensional model. Findings were generally consistent across 3 different types of samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of rigidity across relationships with symptoms and functioning: An investigation with the revised Central Relationship Questionnaire.

The belief that rigidity across relationships is related to greater symptoms and poorer functioning commonly informs the practice of many psychodynamic and interpersonal therapists. Using a profile correlation approach, the authors tested this hypothesis in a sample of 250 clients and 90 undergraduate control participants. Symptoms and functioning were assessed with the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, L. E. Alden, J. S. Wiggins, A. L. Pincus, 2000), Global Assessment of Functioning Scale (American Psychiatric Association, 2000), and Brief Symptom Inventory (L. R. Derogatis, & N. Melisaratos, 1983). A revised version of the empirically derived Central Relationship Questionnaire (CRQ; J. P. Barber, C. Foltz, & R. M. Weinryb, 1998) was used to measure interpersonal patterns. Revisions were made to the CRQ to increase the interpersonal dimensions it captured, reduce its length, and model a higher order factor structure. The psychometric properties of the revised CRQ were found to be adequate. Rigidity, as measured with the CRQ, was not related to rigidity measured with the IIP (amplitude) and did not differ significantly among individuals with different interpersonal problems or Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 2000) diagnoses. Contrary to theory, however, greater rigidity across relationships was related to fewer symptoms and interpersonal problems. These relations did not appear due to the valence or the extremeness of the interpersonal patterns used in the estimation of rigidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression.

The therapeutic alliance consistently predicts positive psychotherapy outcomes. Thus, it is important to uncover factors that relate to alliance development. The goal of this study was to examine the association between patient interpersonal characteristics and alliance quality in interpersonal therapy for depression. Data derive from a subsample (n = 74) of a larger naturalistic database of outpatients treated at a mood disorders clinic of a university-affiliated psychiatric hospital. Following Session 3 of treatment, therapists completed the Impact Message Inventory (Kiesler & Schmidt, 1993) to assess patients' interpersonal impacts on them. Also following Session 3, patients completed the Working Alliance Inventory (Horvath & Greenberg, 1989) to assess alliance quality. As predicted, patients' affiliative interpersonal impacts, as perceived by their therapists, were positively associated with alliance quality, controlling for baseline depression severity. Although unrelated to the initial hypotheses, patients concurrently taking psychotropic medications reported better alliances than patients receiving psychotherapy only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal complementarity and the therapeutic alliance: A study of relationship in psychotherapy.

Examined the relationship between the therapeutic alliance and interpersonal complementarity during the early stage of psychotherapy. 36 pairs of patients (aged 18–57 yrs) and therapists from 14 outpatient settings recorded their perceptions of their therapeutic alliance, using a working alliance inventory, and rated each other's therapy behaviors on the Checklist of Interpersonal Transactions. There were positive associations between patient–therapist interpersonal complementarity and both patients' and therapists' perceptions of the alliance. The more extreme/abnormal the patient's interpersonal behavior, the more both patient and therapist perceived a less positive working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inventory of interpersonal problems: Psychometric properties and clinical applications.

Describes a new instrument, the Inventory of Interpersonal Problems (IIP), which measures distress arising from interpersonal sources. The IIP meets the need for an easily administered self-report inventory that describes the types of interpersonal problems that people experience and the level of distress associated with them before, during, and after psychotherapy. In Study 1, psychometric data are presented for 103 patients who were tested at the beginning and end of a waiting period before they began brief dynamic psychotherapy. On both occasions, a factor analysis yielded the same six subscales; these scales showed high internal consistency and high test–retest reliability. Study 2 demonstrated the instrument's sensitivity to clinical change. In this study, a subset of patients was tested before, during, and after 20 sessions of psychotherapy. Their improvement on the IIP agreed well with all other measures of their improvement, including those generated by the therapist and by an independent evaluator. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal problems, personality pathology, and social adjustment after cognitive therapy for depression.

The authors examined the level and structure- of the Inventory of Interpersonal Problems--Circumplex version (IIP-C; L. M. Horowitz. L. E. Alden, J. S. Wiggins, & A. L. Pincus, 2000) before and after 20 sessions of acute-phase cognitive therapy for depression (N=118), as well as associations with the Schedule for Nonadaptive and Adaptive Personality (L. A. Clark, 1993b) and the Social Adjustment Scale--Self-Report version (M. M. Weissman & S. Bothwell, 1976). Interpersonal problems had a 3-factor structure (Interpersonal Distress, Love, and Dominance), with the latter 2 factors approximating a circumplex, both before and after therapy. Interpersonal Distress decreased and social adjustment increased with therapy, but the Love and Dominance dimensions were relatively stable, similar to personality constructs. Social adjustment related negatively to Interpersonal Distress but not to Love or Dominance. Personality pathology related broadly to Interpersonal Distress and discriminantly to Love and Dominance. These findings support the reliability and validity of the IIP-C and are discussed in the context of personality theory and measurement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural analysis of social behavior as a common metric for programmatic psychopathology and psychotherapy research.

This article describes the use of the Structural Analysis of Social Behavior (SASB; L. Benjamin, 1974) as applied to programmatic psychodynamic-interpersonal psychotherapy research. SASB fosters cumulative, theory-driven research by permitting problem-treatment-outcome (PTO) congruence—the conceptualization and measurement of patients' problems, treatment processes, and outcome in a common metric. In this explication of the principle of PTO congruence, the following are discussed: a general model of interpersonal psychopathology and etiology, SASB-based assessment devices for measuring early history and formulating presenting problems, empirical studies of interpersonal process in therapy, the relationship between manual-guided training and interpersonal process, and the assessment of outcome. A generic interpersonal model of psychotherapy is proposed that theoretically links all of these elements. Finally, the use of these SASB-based models for cross-theory integrative research from a common-factors approach is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of transference work, the therapeutic alliance, and their interaction in reducing interpersonal problems among psychotherapy patients with Cluster C personality disorders.

The aim of the present study was to examine whether transference work, the therapeutic alliance, and their interaction predicted a reduction in interpersonal problems at treatment termination. Forty-nine patients with Cluster C personality disorders from a randomized controlled trial investigating the effectiveness of short-term dynamic psychotherapy and cognitive therapy were included. Transference work was measured with the Inventory of Therapeutic Strategies (Gaston & Ring, 1992), while the therapeutic alliance was measured with the Helping Alliance Questionnaire (Luborsky, Crits-Christoph, Alexander, Margolis & Cohen, 1983). Less emphasis on transference work predicted overall reduced interpersonal problems, whereas the effects of the therapeutic alliance did not reach statistical significance. An interaction effect was also demonstrated, indicating that greater emphasis on transference work performed on patients with lower therapeutic alliance ratings was associated with a smaller reduction in interpersonal problems at termination. However, the results also indicate that a low dose of transference work may be beneficial in reducing interpersonal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and validation of a measure of interpersonal strengths: The Inventory of Interpersonal Strengths.

An Inventory of Interpersonal Strengths (IIS) was developed and validated in a series of large college student samples. Based on interpersonal theory and associated methods, the IIS was designed to assess positive characteristics representing the full range of interpersonal domains, including those generally thought to have negative qualities (e.g., introversion, coldness, submissiveness). The 8 subscales (octants) of the 64-item IIS demonstrated good circumplex features and reliability. Tests comparing Big 5 interpersonal factors, Inventory of Interpersonal Problems (IIP), Battery of Interpersonal Capabilities (BIC), and other interpersonal measures demonstrated convergent and discriminant validity and shared interpersonal structure. The IIS accounted for significant additional variance in life satisfaction and quality of personal relationships beyond the IIP and the BIC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal pathoplasticity in individuals with generalized anxiety disorder.

Recent theories of generalized anxiety disorder (GAD) have emphasized interpersonal and personality functioning as important aspects of the disorder. We examined heterogeneity in interpersonal problems in 2 studies of individuals with GAD (n = 47 and n = 83). Interpersonal subtypes were assessed with the Inventory of Interpersonal Problems–Circumplex (Alden, Wiggins, & Pincus, 1990). Across both studies, individuals with GAD exhibited heterogeneous interpersonal problems, and cluster analyses of these patients' interpersonal characteristics yielded 4 replicable clusters, identified as intrusive, exploitable, cold, and nonassertive subtypes. Consistent with our pathoplasticity hypotheses, clusters did not differ with GAD severity, anxiety severity, or depression severity. Clusters in Study 2 differed on rates of personality disorders, including avoidant personality disorder, further providing support for the validity of interpersonal subtypes. The presence of interpersonal subtypes in GAD may have important implications for treatment planning and efficacy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interpersonal psychotherapy for co-occurring depression and chronic pain.

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover, when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans, and Latinos all report higher rates of pain and depression compared with other groups. This article describes a version of interpersonal psychotherapy tailored for patients with comorbid depression and chronic pain, interpersonal psychotherapy for depression and pain (IPT-P). IPT-P potentially could be delivered to many patient populations in a range of clinical settings, but this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non–treatment-seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option have the potential to improve clinical outcomes for individuals with depression and chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The factorial structure of the Dutch translation of the Inventory of Interpersonal Problems: A test of the long and short versions.

In this article, the authors study the factorial structure of 2 versions (64 items and 32 items) of the Dutch translation of the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, L. E. Alden, J. S. Wiggins, & A. L. Pincus, 2000) in both a clinical sample (n = 382) and a student sample (n = 287). First, the authors test whether both inventories are constituted by correlated uni-dimensional subscales, and they conclude that this is true only for the short version. Second, the authors study whether the correlations between the subscales follow a circumplex pattern. This proves to be true for both versions. Coefficients alpha and correlations between the IIP-64 and IIP-32 subscales are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures.

Nonepileptic seizures (NES) are one of the most common functional (medically unexplained) symptoms seen by neurologists. Although most experts consider psychotherapy the treatment of choice, few therapeutic approaches have been described in detail. Given that NES occur in the context of many different psychopathologies, it remains uncertain whether there is 1 intervention that can benefit all comers or whether it is necessary to offer individualized psychotherapy. This article describes an approach grounded in psychodynamic interpersonal therapy but augmented with elements of cognitive–behavioral therapy, somatic trauma therapy, and the involvement of caregivers and family members. The approach was developed in the setting of a specialist psychotherapy service for patients with functional neurological disorders presenting to British hospital-based neurologists. The authors have previously shown that it is associated with significant improvements in psychological functioning, health-related functioning, and a symptom count. Three case reports illustrate how the treatment can be adapted to meet different patients' needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal self-confirmation and challenge in psychotherapy.

Six therapists and 45 university student clients participated in a study that tested predictions from interpersonal self-confirmation theory (e.g., J. Andrews; see record 1980-21500-001) and applied the predictions to psychotherapy. The prediction that higher levels of interpersonal challenge vs complementary relationships are experienced as more positively and negatively emotionally stimulating was confirmed. These findings support the application of the discrepancy hypothesis of D. Fiske and S. Maddi (1961) and D. McClelland et al (1953) to the realm of interpersonal self-confirmation and challenge. Qualitative data from a case illustration are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using psychodynamic, cognitive behavioral, and control mastery prototypes to predict change: A new look at an old paradigm for long-term single-case research.

This article illustrates a method of testing models of change in individual long-term psychotherapy cases. A depressed client was treated with 208 sessions of control mastery therapy (CMT), an unmanualized approach that integrates elements of psychodynamic therapy (PDT) and cognitive behavioral therapy (CBT). Panels of experts developed prototypes of ideal PDT, CBT, and CMT process using the Psychotherapy Process Q-set (PQS; J. S. Ablon & E. E. Jones, 1999; E. E. Jones, L. A. Parke, & S. Pulos, 1992; E. E. Jones & S. M. Pulos, 1993). Independent observers rated every 4th session (N = 53) with the PQS. Using correlations between ideal and actual PQS ratings followed by paired t tests, the authors compared adherence to the CMT prototype with adherence to plausible alternative models advocated by the PDT and CBT experts. Bivariate time series analyses determined whether prototype adherence predicted an estimated index of symptom change. Results showed that the therapist's behavior was most consistent with the CMT prototype and that this aspect of the CMT prototype along with particular aspects of the other prototypes influenced estimated symptom change. The results, which replicate and extend earlier findings, support the validity of this approach to studying long-term therapies but also highlight its limitations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal sensitivity: Expressivity or perceptivity?

S. E. Snodgrass (1985, 1992) examined interpersonal sensitivity within status-discrepant interactions. Using the correlation between how a participant thought another felt with how that person reported actually feeling, S. E. Snodgrass's measure of interpersonal sensitivity included both the expressivity of one person and the perceptivity of another person. The studies reported here were conducted to clarify the relative contributions of expressivity and perceptivity to this measure. Results indicated that interpersonal sensitivity was associated more with high expressivity on behalf of the sender than with the perceiver's perceptivity. Implications are discussed for research and theory on interpersonal sensitivity, and gender and leadership roles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)