Splitting Kernberg: A critique of Otto Kernberg's notion of splitting.

Critiques O. Kernberg's (1975/1985) notion of splitting by examining its proposed role in normal development and in the borderline disorder. Specific difficulties with the use of a valence metaphor to account for splitting are explored, as well as the relationship between clinical data and metapsychology in Kernberg's object relations theory. Inconsistencies and logical contradictions, as well as the problem of reification, are viewed as making the valence metaphor untenable in Kernberg's metapsychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Cognitive therapy of anxiety disorders: Science and practice.

Reviews the book, Cognitive therapy of anxiety disorders: Science and practice edited by David A. Clark and Aaron T. Beck (2009). Drs. Clark and Beck’s book Cognitive therapy of anxiety disorders: Science and practise is a comprehensive review of cognitive therapy for anxiety from its empirical theoretical foundation to its clinical application to disorders. Although the focus of the text is ultimately on the cognitive treatment of anxiety, the rich theoretical background that is interwoven throughout makes this book of interest to academics and graduate students as well as clinicians. The book is divided into three parts, each with several chapters: 1) cognitive theory and research on anxiety; 2) assessment and intervention techniques used in cognitive therapy for anxiety; and 3) the application of cognitive therapy to specific anxiety disorders (e.g., panic disorder, obsessive– compulsive disorder [OCD]). Overall, this book is an excellent resource for researchers and clinicians working in the field of anxiety disorders. The reference section alone makes it a valuable addition to one’s bookshelf, and the authors have done an excellent job of organising a vast, and at time disparate, body of research into a cohesive review of cognitive theory as it applies to anxiety. Although the treatment chapters may be a bit overly ambitious in attempting to review both the research and the application of the cognitive model to the treatment of specific disorders, the book in its entirety is clearly an essential text for those interested in obtaining a comprehensive understanding of cognitive therapy and anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrative Borderline Adolescent Family Therapy: Meeting the Challenges of Treating Adolescents With Borderline Personality Disorder.

With the growing acceptance of the borderline personality disorder diagnosis for adolescents has come a need for specialized treatments for this challenging population. Further, because of the prominence of the family system during early and later adolescence, family treatments are particularly needed. The purpose of this article is to present the integrative borderline adolescent family therapy (I-BAFT) model that emerged from a National Institute on Drug Abuse-funded (Stage 1) treatment development and enhancement effort. I-BAFT integrates (a) key interventions from the family treatment of adolescent drug abuse (D. A. Santisteban et al., 2003; J. Szapocznik & W. Kurtines, 1989), (b) skills training shown effective with adults with borderline personality disorder (M. Linehan, 1993a) and adapted for adolescents, and (c) individual treatment interventions that promote motivation for treatment and enhance the integration of the 3 treatment components. (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)     

Effects of coping-oriented couples therapy on depression: A randomized clinical trial.

The aim of this study was to evaluate the effectiveness of treating depression with coping-oriented couples therapy (COCT) as compared with cognitive-behavioral therapy (CBT; A. T. Beck, C. Ward, & M. Mendelson, 1961) and interpersonal psychotherapy (IPT; M. M. Weissman, J. C. Markowitz, & G. L. Klerman, 2000). Sixty couples, including 1 clinically depressed partner, completed pre- and posttest questionnaires as well as follow-up assessments at 6-month intervals over the subsequent 1.5 years. Effects of the 3 treatments on depressive symptomatology assessed by the Beck Depression Inventory (A. T. Beck, A. J. Rush, B. L. Shaw, & G. Emery, 1979) and Hamilton Rating Scale for Depression (M. Hamilton, 1960); recovery rates; and relapse rates were examined. Additionally, changes in relationship quality were evaluated. Results suggest that the COCT is as effective in improving depressive symptomatology as are the well-established, evidenced-based CBT and IPT approaches. The COCT did not demonstrate a significantly better outcome with regard to self-reported relationship satisfaction or dyadic coping; however, it did produce significant improvements in partners' expressed emotion, changes that were not seen in other treatment conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A manual-based psychodynamic therapy for treatment-resistant borderline personality disorder.

The authors introduce a manual-based treatment, labeled dynamic deconstructive psychotherapy, developed for those patients with borderline personality disorder who are most difficult to engage in therapy, such as those having co-occurring substance use disorders. This treatment model is based on the hypothesis that borderline pathology and related behaviors reflect impairment in specific neurocognitive functions, including association, attribution, and alterity that form the basis for a coherent and differentiated self. Dynamic deconstructive psychotherapy aims to activate and remediate neurocognitive self-capacities by facilitating elaboration of affect-laden interpersonal experiences and integration of attributions, as well as providing novel experiences in the patient-therapist relationship that promote self-other differentiation. Treatment involves weekly individual sessions for a predetermined period of time and follows sequential stages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mind/body dualism in medicine: The case of chronic pelvic pain without organic pathology: a critical review of the literature

Chronic pelvic pain in the absence of organic pathology identifiable in medical terms is considered one of the most perplexing conditions that gynecologists confront. A critical analysis of the medical, psychiatric, and psychological literature on chronic pelvic pain without organic pathology reveals that the dichotomous construct of mind and body underpinning medical research and understanding is a barrier to the successful diagnosis and treatment of this condition, and indeed to the productive engagement of the health professional with the patient. The strict duality of the condition's etiology being understood in either physiological or psychogenic terms has been questioned at times over the last 40 years, but only recently has an "integrative model" been proposed. However, it is argued here that although the development of a multidisciplinary approach is important, only a radical deconstruction of the medical paradigm will truly address the problem and enable a real change in practice.     

Review of The integrative power of cognitive therapy.

Reviews the book, The integrative power of cognitive therapy by Brad A. Alford and Aaron T. Beck (see record 1997-97373-000). This book makes a case for Cognitive Therapy (CT) as the integrative paradigm for psychotherapy. The writing instructs the reader in Cognitive Therapy and advocates its superiority to other approaches, especially the so-called psychotherapy integration movement of the Society for Exploration of Psychotherapy Integration (SEPI), to integrate the diversity that is contemporary psychotherapy. The authors want to show us the way into the twenty-first century, and there are far worse guides for us to follow. CT is comprehensive in theory and technique, and it is sensibly grounded in empirical findings and to a lesser extent in cognitive psychology. Nonetheless, some will be reluctant to grant a monopoly to Beck and his successors. All should read this book and decide on which side of the issue to stand. At the very least, the reader will learn about CT or have previous learning consolidated, and will engage in a provocative debate about the nature and future of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A self-control behavior therapy program for depression.

A behavior therapy program based on a self-control model of depression was evaluated against a nonspecific group therapy condition and a waiting list control group, 28 depressed volunteer female Ss ages 18–48 were administered a psychological test battery including the Beck Depression Inventory and the MMPI and randomly assigned to 1 of the 3 experimental conditions. The experimental therapy procedure consisted of a 6-wk group treatment program that sequentially focused on modifying self-monitoring, self-evaluation, and self-control skills. In each phase specific self-control principles were discussed in conjunction with behavioral homework assignments involving activity schedules. The self-control therapy Ss showed significantly greater reduction in depression on self-report and behavioral measures. Self-control Ss also showed greater improvement in overall pathology on the MMPI. There was some evidence that self-control Ss improved on specific measures of self-control behavior. A 6-wk follow-up generally confirmed maintenance of improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An empirical study of the psychodynamics of borderline impulsivity: A preliminary report.

The aim of this article is to position borderline impulsivity, as defined by direct and indirect impulsive self-destructive behaviors, within the framework of Kernberg's (1975, 1976) and Masterson's (1976) object relations models and then to test in an exploratory and empirical manner certain hypotheses emerging from this conceptual analysis. We assessed 29 participants using the Impulse Action Patterns section of the Diagnostic Interview for Borderlines—Revised, measuring direct and indirect self-destructive behaviors; the 11th version of the Barratt Impulsiveness Scale, measuring impulsive personality traits; the Subjective Emotion Questionnaire; and two dimensions of the Social Cognition and Object Relations Scale applied to stories from the Thematic Apperception Test and suspected to be related to borderline impulsivity (i.e., affect–tone of relationship paradigms and capacity for emotional investment in values and moral standards). These two dimensions were significantly associated with, and helped predict, self-destructive behaviors. In turn, self-destructive behaviors were associated with impulsive personality traits. We interpreted these findings using the object relations model to posit certain hypotheses on the psychological mechanisms underlying this relationship and to stimulate future research. Finally, we discuss the importance of using the components of personality structure as conceived in the object relations model to better understand borderline impulsivity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Cognitive therapy for depressed adolescents.

Reviews the book, Cognitive therapy for depressed adolescents by T. C. R. Wilkes, Gayle Belsher, A. John Rush, and Ellen Frank (see record 1994-98433-000). This book offers chapters on adaption of cognitive therapy for depressed adolescents, ten key principles of adolescent cognitive therapy, diagnosis and assessment, developmental considerations, the therapeutic relationship, family involvement, the initial phase, the middle phase, the final phase, three comorbidity chapters (substance abuse, sexual victimization, suicidal adolescents), hospitalized adolescents, psychopharmacological treatment, and treatment failures. The sequence of chapters makes perfect sense, and despite four senior authors and five co-authors, it is as if one master hand prevails. The writing never wavers—crisp, flowing, and superbly readable. Whenever possible, adolescent and adult therapy of depression are contrasted, and at times, techniques effective or ineffective for early and late adolescents are cited. One might say the current work is a downward extension of the 1979 Beck book, with developmental considerations and family therapy included. This manual motivates me to reread Beck, Burns, Piaget, Bowlby, and the Socratic method series of papers in this Journal (Overholser). Manuals such as this should result in improved supervision. Finally, Drs. Wilkes, Belsher, Rush, Frank, and their associates (Drs. David A. Brent, Graham J. Emslie, Miriam S. Lerner, Anthony Nowels, Warren A. Weinberg) provide this reviewer with one more humility and awe inducing experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Cognitive therapy for depressed adolescents.

Reviews the book, Cognitive therapy for depressed adolescents by T.C. R. Wilkes, Gayle Belsher, A. John Rush, and Ellen Frank (see record 1994-98433-000). This book offers chapters on adaption of cognitive therapy for depressed adolescents, ten key principles of adolescent cognitive therapy, diagnosis and assessment, developmental considerations, the therapeutic relationship, family involvement, the initial phase, the middle phase, the final phase, three comorbidity chapters (substance abuse, sexual victimization, suicidal adolescents), hospitalized adolescents, psychopharmacological treatment, and treatment failures. The sequence of chapters makes perfect sense, and despite four senior authors and five co-authors, it is as if one master hand prevails. The writing never wavers—crisp, flowing, and superbly readable. Whenever possible, adolescent and adult therapy of depression are contrasted, and at times, techniques effective or ineffective for early and late adolescents are cited. One might say the current work is a downward extension of the 1979 Beck book, with developmental considerations and family therapy included. This manual motivates me to reread Beck, Burns, Piaget, Bowlby, and the Socratic method series of papers in this Journal (Overholser). Manuals such as this should result in improved supervision. Finally, Drs. Wilkes, Belsher, Rush, Frank, and their associates (Drs. David A. Brent, Graham J. Emslie, Miriam S. Lerner, Anthony Nowels, Warren A. Weinberg) provide this reviewer with one more humility and awe inducing experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of response to treatment in a randomized clinical trial of marital therapy.

This study investigated demographic, intrapersonal, and interpersonal predictors of treatment response in a randomized clinical trial of 134 distressed married couples, which examined traditional (N. S. Jacobson & G. Margolin, 1979) and integrative (N. S. Jacobson & A. Christensen, 1996) behavioral couple therapy. Results based on hierarchical linear modeling revealed that interpersonal variables were the strongest predictors, but their effects were largely limited to predicting initial marital dissatisfaction; greater individual mental health was also associated with less distress initially. Couples who were married longer demonstrated stronger treatment gains, and exploratory analyses suggested that sexually dissatisfied couples showed slower initial, but overall more consistent, gains in the integrative versus the traditional approach. Findings are considered in light of the previous literature on predicting response to marital therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Models of brief psychodynamic therapy.

Reviews the book, Models of brief psychodynamic therapy by Stanley B. Messer and C. Seth Warren. This book is suitable for supplementary reading in a graduate psychotherapy course, and is intended for graduate students in the field of clinical and counseling psychology. It is also intended as a concise reference work on brief psychodynamic therapies for clinicians who are or wish to practice in the newer mode of limited goals and limited sessions. The authors consider drive theory based psychotherapy treatment, as well as integrative and eclectic models of brief psychodynamic therapy. In consideration of each of the various approaches, Messer and Warren have primarily concerned themselves with four issues as a focal point of their analysis: (a) the theory of pathology involved; (b) the development of a clinical focus; (c) patient selection considerations, including indications and contraindications; and (d) typical techniques associated with the treatment involved. This text is an excellent addition to the literature, primarily for adjunct reading in graduate courses on psychotherapy. It also affords the opportunity for psychodynamically oriented clinicians to address a need for an overview and grounding in brief treatment models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse.

This study compared the effectiveness of cognitive processing therapy for sexual abuse survivors (CPT-SA) with that of the minimal attention (MA) given to a wait-listed control group. Seventy-one women were randomly assigned to 1 of the 2 groups. Participants were assessed at pretreatment and 3 times during posttreatment: immediately after treatment and at 3-month and 1-year follow-up, using the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (D. Blake et al., 1995), the Beck Depression Inventory (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the Structured Clinical Interview for the DSM-IV (R. L. Spitzer, J. B. W. Williams, & M. Gibbon, 1995; M. B. First et al., 1995), the Dissociative Experiences Scale-II (E. M. Bernstein & F. W. Putnam, 1986), and the Modified PTSD Symptom Scale (S. A. Falsetti, H. S. Resnick, P. A. Resick, & D. G. Kilpatrick, 1993). Analyses suggested that CPT-SA is more effective for reducing trauma-related symptoms than is MA, and the results were maintained for at least 1 year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalytic therapy of the borderline patient: Treating the fusion-separation contradiction.

The thesis of the article is that borderline psychopathology can be successfully treated by psychoanalytic therapy, and the principles of this treatment are outlined. Borderline psychopathology is defined as fusion in close relationships and reality adaptation in other situations. Thus, the major treatment issue is seen as the resolution of the transference psychosis. The article makes a distinction between overt and covert transference psychosis and demonstrates how both forms may be treated through interpretive means. A case treated in this manner is used to demonstrate the resolution of the transference psychosis with primary reliance on interpretation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Supportive therapy for borderline patients—A psychodynamic approach.

Reviews the book, Supportive therapy for borderline patients—A psychodynamic approach by Lawrence H. Rockland (see record 1992-97952-000). In this book, the author addresses the supportive psychotherapy of clients with Borderline Personality Disorder (BPD). While there is an abundant literature on expressive and psychoanalytic treatments for the borderline client there is very little on supportive approaches in the psychotherapy literature. Rockland offers a guide to the therapist who, after careful assessment and treatment planning, decides that a primarily supportive psychotherapy is most appropriate for his/her client, either initially or throughout the treatment. Using a practical, how-to format, Rockland applies the principles of Psychodynamically Oriented Supportive Therapy (POST)—an approach that he formulated (Rockland, 1989)—to clients with BPD. This text will assist clinicians in conceptualizing interventions that are often already part of their "supportive" repertoire but are applied in an unorganized and unsystematic fashion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An open trial of integrative therapy for generalized anxiety disorder.

Cognitive-behavioral therapy (CBT), although effective, has the lowest average effect size for generalized anxiety disorder (GAD), when compared to effect sizes of CBT for other anxiety disorders. Additional basic and applied research suggests that although interpersonal processes and emotional avoidance may be maintaining GAD symptomatology, CBT has not sufficiently addressed interpersonal issues or emotion avoidance. This study aimed to test the feasibility and preliminary efficacy of an integrative psychotherapy, combining CBT with techniques to address interpersonal problems and emotional avoidance. Eighteen participants received 14 sessions of CBT plus interpersonal emotional processing therapy and three participants (for training and feasibility purposes) received 14 sessions of CBT plus supportive listening. Results showed that the integrative therapy significantly decreased GAD symptomatology, with maintenance of gains up to 1 year following treatment. In addition, comparisons with extant literature suggested that the effect size for this new GAD treatment was higher than the average effect size of CBT for GAD. Results also showed clinically significant change in GAD symptomatology and interpersonal problems with continued gains during the 1-year follow-up. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gestalt therapy and cognitive therapy—Contrasts or complementarities?

The article investigates the relationship between crucial concepts and understandings in gestalt therapy and cognitive therapy aiming at discussing if and how they can be mutually enriching when considered as complementary parts in a more encompassing integrative therapeutic approach. It is argued that gestalt therapy, defined as a field-theoretical approach to the study of gestalt formation process, can complement the schema-based understanding and practice in cognitive therapy. The clinical benefits from a complementary view of the two approaches will be a wider scope of awareness toward individual and contextual aspects of therapeutic change processes, toward different levels of memory involved in these processes, and toward the relationship between basic needs, sensation and cognition in therapeutic work. Further, a dialogue between the two approaches will pave the way for addressing the connection between fundamental awareness work in gestalt therapy and the tendency within cognitive therapy toward incorporating mindfulness as a therapeutic tool. In the conclusion of the article, additional complementary points between the two approaches are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A biosocial developmental model of borderline personality: Elaborating and extending linehan’s theory.

Over the past several decades, research has focused increasingly on developmental precursors to psychological disorders that were previously assumed to emerge only in adulthood. This change in focus follows from the recognition that complex transactions between biological vulnerabilities and psychosocial risk factors shape emotional and behavioral development beginning at conception. To date, however, empirical research on the development of borderline personality is extremely limited. Indeed, in the decade since M. M. Linehan initially proposed a biosocial model of the development of borderline personality disorder, there have been few attempts to test the model among at-risk youth. In this review, diverse literatures are reviewed that can inform understanding of the ontogenesis of borderline pathology, and testable hypotheses are proposed to guide future research with at-risk children and adolescents. One probable pathway is identified that leads to borderline personality disorder; it begins with early vulnerability, expressed initially as impulsivity and followed by heightened emotional sensitivity. These vulnerabilities are potentiated across development by environmental risk factors that give rise to more extreme emotional, behavioral, and cognitive dysregulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)