Any research on patient personality disorder as it impacts patient-therapist interactions or the therapeutic alliance since 2010.
For example: Tufekclioglu, S., Muran, J.C., Safran, J.D., & Winston, A. (2013). Personality disorder and early therapeutic alliance in two time-limited therapies. Psychotherapy Research.
And of course since Bender (2005, see attached):
Columbia University College of Physicians and Surgeons, and Department of Personality Studies, New York State Psychiatric Institute, New York, NY 10032, USA.
Journal of Psychiatric Practice (Impact Factor: 1.29). 04/2005; 11(2):73-87. DOI: 10.1097/00131746-200503000-00002
Source: PubMed
Dear Christopher, first of all, many compliments for your own work. I think another interesting work in this field is that by Lingiardi, Colli, and colleagues, who looked at the therapists' responses in association with disordered personality traits as measured by the Shedler-Westen Assessment Procedure. The reference is: Colli, A., Tanzilli, A., Dimaggio, G., & Lingiardi, V. Patient personality and therapist response: An empirical investigation. The American Journal of Psychiatry, 171(1), 102-108. http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2013.13020224
Hi Chris, and thanks to Adriano for indicating my paper.
Happy New Year,
Vittorio
Happy New Year to you both!
Here's a pdf to introduction of special issue on PDs in Psychotherapy Research:
Investigating the personality disorder psychotherapy process: The roles of symptoms, quality of affects, emotional dysregulation, interpersonal processes, and mentalizing Giancarlo Dimaggioa, Giuseppe Nicolòb, Antonio Semerarib & Antonino Carcioneb a Centro Di Terapia Metacognitiva Interpersonale, Rome, Italy b Terzo Centro di Psicoterapia Cognitiva, Scuola di formazione in Psicoterapia Cognitiva APC/SPC, Italy Published online: 19 Nov 2013.
Thank you, Christopher. An interesting paper. I think Dimaggio and colleagues are right in highlighting the role of alexithymia and reduced mentalization abilities in PDs. Many PD patients-especially those in the DSM "Cluster B"-have difficulties in identifying feelings (first factor of alexithymia) and they often lack of mentalized affectivity, thus their affect tolerance is really low, and this may foster problem behaviors and symptoms that further reinforce their negative feelings.It's like a vicious circle. On a clinical level, I think that projective identification of unrecognized, unbearable states of mind and feelings of confusion and helplessness into the therapist is one of the main problems to address with them, especially in the first stages of therapy, otherwise working alliance will not develop properly, and the risks for acting-out behaviors and even drop-out from treatment may dramatically increase, but I do not know if research exists on this topic (I think not so many researchers/clinicians would be happy to do research on therapeutic failures...).
Thank you, Adriano. Yes, I'm not aware of such research, but I do encourage more research on treatment failure - or when things get difficult - my bias for sure. Best, Chris
Adriano, here are three articles from the special issue on PDs in Psychotherapy Research that concern alexithymia & mentalization.
Dear Chris, thank you very much! I was eager to read more about these topics, and their clinical implications in particular. I will read these papers asap! All best wishes.
Dear Chris, I have now read the papers and I was particularly impressed by the results concerning alexithymia. In fact, I expected that reflective functioning would relate with treatment outcomes and even mediated them: on a clinical level it is rather clear that a higher ability to look into one's own and others' mental states is a positive indicator for treatment purposes (eg the ability to take others' perspectives might help PD patients in developing a more balanced view about the effects of their behaviors on other people, which in turn might foster the capacity to better relate, and so on). I was surprised instead about findings of one study showing that alexithymia had a marginal role in treatment outcomes. Looking at the results of partial correlations and regression analyses, it seems to me that a major problem with that study is about the choosen measure to assess alexithymia. Alexithymia is in fact a multifaceted construct, which involves two higher-order factors-- lack of affect awareness and operative thinking, as showed by Taylor, Bagby and colleagues when they analyzed the factor structure of their TSIA interview on alexithymia. The TAS -20 is a great self-report for screening purposes, but its questions refers to conscious dispositions toward the individual's emotional processes, which in fact might not reflect his or her current attitudes and behaviors, especially if he/she is partially unaware of his/her emotional processing. For example, I remember a a BPD patient who scored quite low in the TAS -20, who answered there that he used his own feelings as a guide for his behavior, but when interviewed with the TSIA and asked for an example of this item, said: "In fact, I had no one.If I think better on this, my behavior is based more on what other people think about me."
Thank you again for sharing these papers with me. All best wishes for a happy New Year,
Adriano
Thank you, Adriano, for your thoughtful comments, & best wishes for the new year, Chris
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