Are all narratives the same: Convergent and discriminant validity of the Social Cognition and Object Relations Scale-Global Rating Method across two narrative types.

This study examines the construct validity of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) by exploring the degree of convergence across different narrative sources (i.e., early memories [EM] and psychotherapy narratives [PT]) using a university-based outpatient sample (n = 101). First, we examined intercorrelations between SCORS-G ratings of EM and PT. Intercorrelations between SCORS-G EM and PT revealed that three of the dimensions significantly correlated with themselves across narrative type (Emotional Investment in Relationships [EIR], Experience and Management of Aggressive Impulses [AGG], and Self-Esteem [SE]), but that only AGG had its strongest correlation with itself (i.e., EM AGG to PT AGG). In addition, EM AGG was significantly related to all but one of the PT SCORS-G dimensions. Likewise, EM SE correlated with all but two of the PT SCORS-G dimensions. Second, we examined how narrative source related to clinical findings. With the use of a multimethod approach, we assessed how SCORS-G ratings from both narrative types correlated with selected variables from the Personality Assessment Inventory (PAI) and Rorschach Inkblot Test. Findings indicated that there were only three instances in which both narrative types had significant relationships to the same variable/scale, and all three instances were with the Rorschach. Together, these findings suggest that even when using the same scale (SCORS-G), different narrative sources differentially activate aspects of object relations. In addition, the results highlight that difficulties with self-esteem and poor management of aggression in childhood interactions relates to patients' object relational functioning later in life. Clinical implications and future research are discussed.

Dimensional measure of self and interpersonal functioning: Comparisons with treatment alliance and readiness for inpatient psychotherapy.

The social cognition and object relations scale-global rating method is a clinical rating system assessing 8 domains of self and interpersonal functioning. It can be applied to score numerous forms of narrative data. In this study, we investigate the SCORS-G relationship to measures of alliance and readiness for psychotherapy with an adolescent inpatient sample. Seventy-two psychiatrically hospitalized adolescents were consented and subsequently rated by their individual and group therapist using the SCORS-G. The unit psychiatrist also completed an assessment of patients' readiness for inpatient psychotherapy. The patients completed a self-report of their alliance with the inpatient treatment team as a whole. SCORS-G ratings were positively correlated with assessments of readiness for inpatient psychotherapy and patient-reported alliance. This study further demonstrates the clinical utility of the SCORS-G with adolescents.

Reliability and Validity of Prototype Diagnosis for Adolescent Psychopathology.

The current study investigated the interrater reliability and validity of prototype ratings of 5 common adolescent psychiatric disorders: attention-deficit/hyperactivity disorder, conduct disorder, major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder. One hundred fifty-seven adolescent inpatient participants consented to participate in this study. We compared ratings from 2 inpatient clinicians, blinded to each other's ratings and patient measures, after their separate initial diagnostic interview to assess interrater reliability. Prototype ratings completed by clinicians after their initial diagnostic interview with adolescent inpatients and outpatients were compared with patient-reported behavior problems and parents' report of their child's behavioral problems. Prototype ratings demonstrated good interrater reliability. Clinicians' prototype ratings showed predicted relationships with patient-reported behavior problems and parent-reported behavior problems. Prototype matching seems to be a possible alternative for psychiatric diagnosis. Prototype ratings showed good interrater reliability based on clinicians unique experiences with the patient (as opposed to video-/audio-recorded material) with no training.

Clinical validity of a dimensional assessment of self- and interpersonal functioning in adolescent inpatients.

The Social Cognition and Object Relations Scale-Global Version (SCORS-G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS-G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS-G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS-G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS-G with adolescents.

Validation of a measure of alliance for an adolescent inpatient setting.

UNLABELLED: The link between alliance and treatment outcome is robust. Nevertheless, few, if any, self-report measures exist to assess the alliance between hospitalized adolescents and their treatment team as a whole. The present study looks to extend the use of a brief self-report measure of inpatient treatment alliance designed for adult inpatients to be used with adolescents. The scale is designed incorporating items that tap the three factors of alliance (bond, goals and collaboration) to assess the alliance that the patient has with his or her treatment team. Our results show that the Inpatient-Treatment Alliance Scale is unifactoral, shows good psychometrics and is linked in theoretically meaningful ways to global clinician ratings of engagement in individual psychotherapy. KEY PRACTITIONER MESSAGE: Inpatient treatment of adolescents requires the assessment of alliance to be between the patient and his or her treatment team rather than an individual clinician. Assessment of the alliance can benefit clinicians treating hospitalized adolescents especially because these patients are difficult to engage with in treatment. This study shows that the Inpatient-Treatment Alliance Scale is a promising measure for assessing treatment alliance on an adolescent inpatient setting.

Assessing overall functioning with adolescent inpatients.

The current study sought to evaluate the validity and reliability of a brief measure of overall functioning for adolescents. Clinicians were asked to complete the Overall Functioning Scale (OFS) for 72 adolescents consecutively admitted to the adolescent psychiatric inpatient service of a community safety net medical center. The results revealed that this new measure is related to the patients' length of stay, clinician-rated measures of social cognition and object relations, Global Assessment of Functioning (GAF) score at admission, as well as global rating of engagement in individual psychotherapy. The results also showed that the OFS was related to the patients' history of nonsuicidal self-harm as well as treatment outcome as assessed by measures of psychological health and well-being as well as symptoms. Hierarchical regressions reveal that the OFS shows incremental validity greater than the admission GAF score in predicting length of stay. The results also showed that the OFS demonstrates interrater reliability in the excellent range (intraclass correlation coefficient(1,2)) of 0.88. Clinical implications of the use of this tool and areas of future research are discussed.

An examination of generalized anxiety disorder and dysthymia utilizing the Rorschach inkblot method.

This study examined transdiagnostic features of generalized anxiety disorder (GAD) and dysthymia in an outpatient clinical sample. Fifteen patients who met DSM-IV criteria for GAD and twenty-one patients who met DSM-IV criteria for dysthymia but who did not have comorbid anxiety disorder were evaluated utilizing the Rorschach. Salient clinical variables were then compared. Results showed that patients with GAD scored significantly higher on variables related to cognitive agitation and a desire/need for external soothing. In addition, there was a trend for patients with GAD to produce higher scores on a measure of ruminative focus on negative aspects of the self. Thus, not surprisingly, GAD patients' experienced more distress than the dysthymic patients. The implications of these findings are discussed with regards to better understanding the shared and distinct features of GAD and dysthymia.

Correlates of interpersonal dependency and detachment in an adolescent inpatient sample.

Interpersonal dependency has been linked to psychological distress, depression, help seeking, treatment compliance, and sensitivity to interpersonal cues in adult samples. However, there is a dearth of research focusing on dependency in child and adolescent samples. The current study examined the construct validity of a measure of interpersonal dependency. The authors investigated how interpersonal dependency and detachment relate to behavioral problems, subjective well-being, interpersonal problems, and global symptom severity in adolescent inpatients. Destructive overdependence (DO) and dysfunctional detachment (DD) were positively related to interpersonal distress, behavioral problems, and symptom severity and negatively related to psychological health and well-being. Healthy dependency (HD) was associated with fewer behavioral problems and less symptom severity and positively related to subjective well-being. The clinical implications of these findings are discussed.

Determining adolescents' suitability for inpatient psychotherapy: utility of the clinician-rated Readiness for Inpatient Psychotherapy Scale with an adolescent inpatient sample.

Growing economic pressure on inpatient services for adolescents has resulted in fewer clinicians to provide individual psychotherapy. As a result, inpatient treatment trends have favored group psychotherapy modalities and psychopharmacological interventions. Currently, no clinician-rated measures exist to assist clinicians in determining who would be able to better utilize individual psychotherapy on inpatient units. The current study sought to demonstrate the utility of the Readiness for Inpatient Psychotherapy Scale with an adolescent inpatient sample. This study also used the RIPS as it is intended to be used in everyday practice. Results from the authors' analyses reveal that the RIPS demonstrates good psychometrics and interrater reliability, as well as construct validity.

Should I stay or should I go? Personality Assessment Inventory and Rorschach indices of early withdrawal from psychotherapy.

The Personality Assessment Inventory (PAI) and the Rorschach were used to investigate differences between patients who withdrew early from university-based outpatient psychodynamic psychotherapy and those who continued in treatment. The study employs two sets of analyses, one utilizing the complete sample (N = 101) and a second comprised of comparison pairs matched on the specific therapist delivering treatment (n = 36 for Rorschach; n = 38 for PAI). It was hypothesized that early withdrawers would score higher on the PAI Treatment Rejection Scale (RXR) and the PAI Treatment Process Index (TPI) than treatment continuers. It was also hypothesized that early treatment withdrawers will have better overall interpersonal relationships, less need for closeness and intimacy, less available psychological resources and more current stimulus demands, and lower levels of psychological/cognitive disturbance as measured by the Rorschach. In addition, differences between the two groups on PAI treatment and clinical scales and subscales were examined. Results indicated that PAI RXR differentiated between the two groups (p< .05) in the expected direction. Limited differences between withdrawers and continuers were found on the Rorschach and other PAI scales. Potential explanations for the findings as well as a discussion of clinical applicability are presented.

Rorschach assessment of reality testing, affect and object representation of borderline pathology: a comparison of clinical samples.

This study examines the personality functioning of outpatients diagnosed with borderline pathology (BP) compared to a nonborderline pathology Axis I clinical control group (NonBP). Interrater reliability for all variables was in the good or excellent range. Significant differences were found examining Rorschach variables assessing dysphoric affect and affect regulation/experiencing with BP when compared to the Axis I group. Additionally, individuals with BP had more malevolent object representations than individuals with only Axis I disorders. The clinical implications of these findings with regard to borderline pathology are discussed.