Clinician emotional response toward narcissistic patients. A preliminary report

Patients with narcissistic personality disorder (NPD) are among the most difficult to treat in therapy, especially for their strong resistance to treatment and several difficulties in establishing a therapeutic relationship characterized by intimacy, safety, and trust. In particular, therapists’ emotional responses to these patients can be particularly intense and frustrating, as often reported in the clinical literature; however, rarely they were investigated empirically. The aims of this preliminary study were: 1) to examine the associations between patients’ narcissistic personality disorder and distinct therapists’ countertransference patterns; and 2) to verify whether these clinicians’ emotional reactions were influenced by theoretical orientation, gender and age. A national sample of psychiatrists and clinical psychologists (N = 250) completed the Therapist Response Questionnaire (TRQ) to identify patterns of therapist emotional response, and the Shedler-Westen Assessment Procedure-200 (SWAP-200) to assess personality disorder and level of psychological functioning in a patient currently in their care, and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week). From the complete therapist sample, we identified a subgroup (N = 35) of patients with NPD. Results showed that NPD was positively associated with criticized/mistreated and disengaged countertransference, and negatively associated with positive therapist response. Moreover, the relationship between patients’ NPD and therapists’ emotional responses was not dependent on clinicians’ theoretical approach (as well as their age and gender). These findings are consistent with clinical observations, as well as some empirical contributions, and have meaningful implications for clinical practice of patients suffering from this challenging pathology

Returning to the roots. A Comment on the Paper Alliance in Common Factor Land: A View through the Research Lens

In his interesting paper “Alliance in Common Factor Land: A View through the Research Lens†Horvath (2011) takes us through the critical aspects of therapeutic alliance researches and the challenges that researchers still have to face. The author discusses several complex issues from the historical background of the construct to the critical aspects of its measurement, and concluding with the proposal of a research agenda. The key topic of Horvath’s (2011) paper is the necessity for a better definition of therapeutic alliance construct, one that would (a) recognize the similarities and differences among the different kinds of therapeutic alliance definitions; and (b) differentiate the components of the therapeutic relationship.  As Horvath reminds us in his paper, the problem of differentiation between therapeutic alliance and other components of the relationship originates from Greenson’s (1965) tripartition of therapeutic relationship in transference, working alliance, and real relationship

Factor Structure, Reliability, and Validity of the Therapist Response Questionnaire

open4noThe aim of this study was to examine the stability of the factor structure and psychometric properties of the Therapist Response Questionnaire (Betan, Heim, Zittel Conklin, & Westen, 2005; Zittel Conklin & Westen, 2003), a clinician report instrument able to measure the clinician's emotional reactions to the patient in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 332) of psychodynamic and cognitive-behavioral orientation completed the Therapist Response Questionnaire, as well as the Shedler-Westen Assessment Procedure-200 (Westen & Shedler, 1999a, 1999b), to assess personality disorders and level of psychological functioning, regarding a patient currently in their care. They also administered the Symptom Checklist-90-Revised (Derogatis, 1994) to the patients. Exploratory and confirmatory factor analyses revealed 9 distinct countertransference factors that were similar to 8 dimensions identified in the original version of the measure: (a) helpless/inadequate, (b) overwhelmed/disorganized, (c) positive/satisfying, (d) hostile/angry, (e) criticized/devalued, (f) parental/protective, (g) special/overinvolved, (h) sexualized, and (i) disengaged. These scales showed excellent internal consistencies and good validity. They were especially able to capture the quality and intensity of emotional states that therapists experience while treating personality-disordered patients, as well as to better differentiate them; additionally, they tapped into the complexity of clinicians' reactions toward patients experiencing severe psychiatric symptomatology. Results seem to confirm that Therapist Response Questionnaire is a valid and reliable instrument that allows to evaluate patterns of countertransference responses in clinically sensitive and psychometrically robust ways, regardless of therapists' orientations. The clinical and research implications of these findings are addressed. (PsycINFO Database RecordopenTanzilli, Annalisa; Colli, Antonello; Del Corno, Franco; Lingiardi, VittorioTanzilli, Annalisa; Colli, Antonello; Del Corno, Franco; Lingiardi, Vittori

Text Analysis within Quantitative and Qualitative Psychotherapy Process Research: Introduction to Special Issue

The present paper introduces the special issue on Text Analysis in Quantitative and Qualitative Psychotherapy Process Research. The motivation for this special issue grew out of recognition of the following: (1) both quantitative and qualitative psy-chotherapy process research (PPR) make extensive use of text analysis (TA); (2) TA presents different characteristics that serve different aims in quantitative and qualitative PPR; and (3) researchers are not always fully aware of these differences in explicit and systematic ways. The present paper, together with the special issue it introduces, aims at stimulating a more explicit and systematic methodological reflection on the different ways in which TA may be used in quantitative and qualitative PPR. We first outline the general differences between TA in quantitative and qualitative PPR; then, we describe the extent to which the papers in this special issue illustrate these differences. Finally, we conclude by stressing that PPR may significantly benefit from researchers becoming more fully aware of the differences

Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis

Background: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in several mental disorders. Some studies have suggested that eating disorders (EDs) may also be associated with impairments in mentalizing. The aim of this work is to investigate the possible presence of mentalizing subtypes in a sample of patients with EDs. Method: A sample of patients with eating disorders (N = 157) completed a battery of measures assessing mentalization and related variables, including the Reflective Functioning Questionnaire (RFQ), the Difficulties in Emotion Regulation Strategies (DERS), the Interpersonal Reactivity Index (IRI). Clinicians rated patients in relation to imbalances in different dimensions of mentalization to prementalizing modes and attachment style by using the Mentalization Imbalances Scale, the Modes of Mentalization Scale (MMS), and the Adult Attachment Questionnaire. A latent profile analysis was conducted to test the possible presence of different subgroups. MANOVA was used to test the possible differences between the four mentalizing profiles in relation to emotion dysregulation (DERS), empathy (IRI), and adequate and impairments in mentalizing (MMS and RFQ). Results: The latent profile analysis suggested the presence of four different profiles in relation to impairments in the dimensions of mentalization: (1) affective/self/automatic imbalances, (2) external imbalance, (3) cognitive/self/automatic imbalances, and (4) cognitive/other/automatic imbalances. Patients belonging to profile 1 are characterized by the prevalence of affective mentalization that overwhelms the capacity to reflect on mental states with an imbalance on the self-dimension; profile 2 patients are excessively focused on the external cues of mentalization; profile 3 patients are characterized by an over-involvement on the cognitive and self-facets of mentalization, with an impairment in adopting the other mind perspective; and profile 4 patients have similar impairments compared to profile 3 patients but with an excessive focus on others and deficits in self-reflection. These profiles were heterogeneous in terms of EDs represented in each group and presented significant differences on various variables such as attachment style, emotion dysregulation, empathy, interpersonal reactivity, and reflective function. This study represents, so far, the first work that confirms the presence of different mentalizing patterns in ED patients. Conclusions: ED patients can be classified in relation to impairments in different dimensions of mentalization above and beyond ED diagnosis

Assessing mentalization in psychotherapy: first validation of the Mentalization Imbalances Scale

The aim of this study was to provide data on the preliminary validation of a clinician-report multidimensional assessment measure of mentalization (Mentalization Imbalances Scale, MIS). A random national sample of psychotherapists (N=190) completed the MIS to identify mentalization imbalances, and the Personality Disorder Checklist to assess the personality disorders (PDs) of randomly selected patients currently in their care. Factor analysis confirmed the presence of six factors that represented different imbalances of mentalization: cognitive, affective, automatic, external, imbalance toward others, and imbalance toward self. We found several significant relationships between patients’ mentalization imbalances and personality pathology. Paranoid, schizoid, and schizotypal PDs were predicted by an imbalance toward self, an imbalance the patients shared with histrionic, avoidant, and obsessive compulsive PDs, whereas dependent, borderline, and histrionic PDs were related to an imbalance toward others. Cognitive imbalance was related to schizoid, narcissistic, and obsessive compulsive PDs, whereas affective imbalance predicted antisocial, borderline, narcissistic and histrionic PDs. Automatic imbalance was related to schizotypal, antisocial, and borderline PDs. MIS represents a reliable and valid measure that can help clinicians at understanding patients’ specific difficulties of mentalization

Diagnosi e valutazione della personalit alleanza terapeutica e scambio clinico nella ricerca in psicoterapia

Questo contributo si propone di fornire una breve rassegna delle principali linee di ricerca seguite negli ultimi anni dal gruppo coordinato da Vittorio Lingiardi. Tra queste, ci soffermeremo in particolare su: a) valutazione e diagnosi della personalità con SWAP-200 e PDM (Psychodynamic Diagnostic Manual); b) sviluppo e validazione di strumenti clinician-report per operazionalizare l'uso del PDM; c) valutazione dei meccanismi di difesa e degli stili difensivi mediante DMRS e sua versione Q sort; d) studio del processo e della relazione terapeutica (alleanza terapeutica, rotture e riparazioni dell'alleanza controtransfert); in particolare, in quest'area di ricerca, ci siamo impegnati nello sviluppo e validazione di nuovi strumenti per la valutazione dei processi di rottura e riparazione dell'alleanza (Collaborative Interaction Scale) e della qualità dell'attaccamento tra paziente e terapeuta (Patient-Therapist Attachment Q Sort); d) sviluppo della ricerca clinica e applicativa sui temi dell'identità di genere, dell'orientamento sessuale e dell'omofobia sociale e interiorizzata

Diagnosi e valutazione della personalit alleanza terapeutica e scambio clinico nella ricerca in psicoterapia

Questo contributo si propone di fornire una breve rassegna delle principali linee di ricerca seguite negli ultimi anni dal gruppo coordinato da Vittorio Lingiardi. Tra queste, ci soffermeremo in particolare su: a) valutazione e diagnosi della personalità con SWAP-200 e PDM (Psychodynamic Diagnostic Manual); b) sviluppo e validazione di strumenti clinician-report per operazionalizare l'uso del PDM; c) valutazione dei meccanismi di difesa e degli stili difensivi mediante DMRS e sua versione Q sort; d) studio del processo e della relazione terapeutica (alleanza terapeutica, rotture e riparazioni dell'alleanza controtransfert); in particolare, in quest'area di ricerca, ci siamo impegnati nello sviluppo e validazione di nuovi strumenti per la valutazione dei processi di rottura e riparazione dell'alleanza (Collaborative Interaction Scale) e della qualità dell'attaccamento tra paziente e terapeuta (Patient-Therapist Attachment Q Sort); d) sviluppo della ricerca clinica e applicativa sui temi dell'identità di genere, dell'orientamento sessuale e dell'omofobia sociale e interiorizzata

Genetic diversity of Italian goat breeds assessed with a medium-density SNP chip

Background: Among the European countries, Italy counts the largest number of local goat breeds. Thanks to the recent availability of a medium-density SNP (single nucleotide polymorphism) chip for goat, the genetic diversity of Italian goat populations was characterized by genotyping samples from 14 Italian goat breeds that originate from different geographical areas with more than 50 000 SNPs evenly distributed on the genome. Results: Analysis of the genotyping data revealed high levels of genetic polymorphism and an underlying North-south geographic pattern of genetic diversity that was highlighted by both the first dimension of the multi-dimensional scaling plot and the Neighbour network reconstruction. We observed a moderate and weak population structure in Northern and Central-Southern breeds, respectively, with pairwise FST values between breeds ranging from 0.013 to 0.164 and 7.49 % of the total variance assigned to the between-breed level. Only 2.11 % of the variance explained the clustering of breeds into geographical groups (Northern, Central and Southern Italy and Islands). Conclusions: Our results indicate that the present-day genetic diversity of Italian goat populations was shaped by the combined effects of drift, presence or lack of gene flow and, to some extent, by the consequences of traditional management systems and recent demographic history. Our findings may constitute the starting point for the development of marker-assisted approaches, to better address future breeding and management policies in a species that is particularly relevant for the medium-and long-term sustainability of marginal regions

AdaptMap: exploring goat diversity and adaptation

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