The impact of mentalization training on the reflective function of novice therapists: a randomized controlled trial.

This study examined whether training can increase the reflective function (RF) of novice therapists about patients with Borderline Personality Disorder (BPD). A total of 48 students in clinical psychology were randomly assigned to mentalization training or didactic training. Their RF regarding patients was assessed with the Therapist Mental Activity Scale (TMAS: Normandin, Ensink, & Maheux, 2012). The RF of trainees assigned to the mentalization training improved significantly, while participants who received traditional didactic training actually became significantly less reflective. These findings show that brief mentalization training can help beginner therapists develop their mentalization capacities with challenging patients.

The impact of level of personality organization on treatment response: a systematic review.

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.

Development of an object relation-based typology of adolescent sex offenders.

The aim of this study was to develop a typology of adolescent sex offenders based on object relations theory and Otto F. Kernberg's model of personality organizations (PO). A secondary objective was to compare the identified subtypes on offense characteristics as well as some psychological variables of adolescent sex offenders. Clinical files from 40 male adolescent sex offenders in treatment were examined. Cluster analysis based on PO and object relations variables identified six subtypes of offenders, in line with Kernberg's PO model. These subtypes differed from one another on various variables pertaining to characteristics of sex offenses, general delinquency, relational/sexual history, and trauma history.

[Treatment of schizoid personality disorder: Reflections of a cinephile]. / Le cinéphile : réflexions sur le traitement d'un trouble de personnalité schizoïde.

While treatment of personality disorders in general is often described as difficult and filled with many obstacles, knowledge is still limited regarding the specific treatment challenges for DSM's Cluster A individuals. The purpose of this paper is to explore these challenges, as illustrated by the case study of a schizoid patient who underwent psychodynamic therapy for over a year. Deep and unconscious interpersonal fears that complicated treatment, and how these fears had to be taken into account in therapeutic interventions, will be explored. Strong countertransference reactions, especially those evoked by long silences and constant management of optimal therapeutic distance, will also be discussed. This paper also proposes some reflections on the limitations of DSM's conceptualization of the schizoid personality disorder, and how a dynamic understanding of relational fears and ambivalence in these patients may be crucial to treatment.

Development and initial validity of the Object Relations Rating Scale.

The aim of this study was to report on the development and the initial validation of the Object Relations Rating Scale (ORRS), which is a measure of in-session enactments of object relations that draws on a psychodynamic conceptualization of personality organization. Forty participants were included in the study, distributed among neurotic, borderline and psychotic personality organizations (PO). Results showed that the interrater reliability of this new measure is good. Two tests of criterion validity support the validity of the measure: the ORRS discriminates well between the three PO groups and it correlates in expected ways with five PO dimensions. Finally, ORRS scales that pertain to the degree of in-session object relation enactments correlated with a measure of transference intensity (convergent validity), and correlations with therapists experience were low as expected (discriminant validity).

Predictors of psychological treatment noncompletion among sexual offenders.

Research indicates that sexual offenders who do not complete their treatment are more likely to reoffend than are those who do complete it (Hanson et al., 2002; Losël & Schmucker, 2005). Several investigators have attempted to identify the characteristics of those individuals who do not complete treatment, most likely with the aim of preventing recidivism and the disastrous consequences that offenders' behavior has for their victims and for society at large. The objective of the present article is to review studies of treatment noncompletion among sexual offenders. We found that between 15% and 86% of sexual offenders do not complete treatment. In addition, results of the 18 studies reviewed diverge to the point where it is difficult to draw unequivocal conclusions about the variables related to the phenomenon. Only antisocial personality disorder and certain features of antisocial personality disorder appear to be related consistently and significantly to the discontinuation of treatment. These features are conceptualized under the three principles of effective treatment for general offenders. We present an analysis of the methodological limitations common to all of the studies reviewed in order to explain why confusion seems to reign supreme in the literature in this area at the present time, and we offer recommendations for future research in light of these limitations.

Psychological dimensions of antisocial personality disorder as predictors of psychotherapy noncompletion among sexual offenders.

The goal of this study was to examine whether psychological dimensions of antisocial personality disorder (ASPD), as conceptualized by Kernberg (1992), could predict psychotherapy noncompletion (PNC) among 50 men found guilty of sexual abuse of children. All participants began a 65-week, court-mandated course of cognitive-behavioral psychotherapy, which 20 (40%) of them did not complete. Pretherapy personality was assessed with the Structured Clinical Interview for DSM Axis II Disorders (First, Spitzer, Gibbon, Williams, & Benjamin, 1997), the Personality Organization Diagnostic Form (Diguer, Normandin, & Hébert, 2001), and Blatt and colleagues' (Blatt, Bers, & Schaffer, 1993; Blatt, Chevron, Quinlan, Schaffer, & Wein, 1988) scales of mental representations, as well as the State-Trait Anger Expression Inventory (Spielberger, 1988). A discriminant function analysis, which explained 46% of the total variance, showed that descriptive (antisocial and narcissistic personality disorders), psychological (primitive defense mechanisms, identity diffusion and self-representations), and demographic (work status and income) variables predicted PNC. The classification analysis correctly classified 78% of the participants. These findings support the hypothesis that psychological dimensions of ASPD help explain PNC among sexual offenders. The authors discuss the theoretical and clinical implications of these results.

The personality organization diagnostic form: development of a revised version.

The purpose of this study is to examine the interrater reliability, validity, and internal consistency of a revised version of the Personality Organization Diagnostic Form (PODF; ), a measure that evaluates the major dimensions of Kernberg's model of Personality Organizations (PO). Results show that the revised PODF can be scored with an interrater reliability ranging from good to excellent for the personality dimensions and the global PO (GPO) score. Factor analysis shows that items tend to regroup according to Kernberg's model. The optimal solution includes 2 factors: a borderline-neurotic continuum and a psychotic factor. Internal consistency and convergence with clinical evaluations also indicate moderate to good validity. Convergent validity with mental health and psychiatric severity is good, and in accordance with Kernberg's model. The revised PODF therefore appears to possess sound psychometric properties, with numerous advantages over its predecessor. Its utility for clinical and research work is also discussed.

[For an empirical approach to object relations]. / Pour une approche empirique des relations d'objet.

In this article, the authors address the concept of object relations and its place within psychodynamic theories regarding personality and, more specifically, in Kernberg's conceptualization of personality disorders and organization. The authors attempt to demonstrate the relevance of an empirical approach to object relations by presenting some of the instruments that are most considered. The Object Relations Rating Scale (ORRS ; Diguer, 2001), a new assessment instrument that is different from the others in that it assesses the therapeutic interaction as a whole, and that it is coherent with Kernberg's model of intervention and considers the overall relational manifestations. Finally, the authors present satisfying metrological ratings of this new instrument.

Personality organization, five-factor model, and mental health.

Otto Kernberg has developed a model of personality and psychological functioning centered on the concept of personality organization. The purpose of this study is to empirically examine the relationships between this model, the five-factor model, and mental health. The Personality Organization Diagnostic Form (Diguer et al., The Personality Organization Diagnostic Form-II (PODF-II), 2001), the NEO Five-Factor Inventory (Costa and McCrae, Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) Professional Manual. 1992a), and the Health-Sickness Rating Scale (Luborsky, Arch Gen Psychiatry. 1962;7:407-417) were used to assess these constructs. Results show that personality organization and personality factors are distinct but interrelated constructs and that both contribute in similar proportion to mental health. Results also suggest that the integration of personality organization and factors can provide clinicians and researchers with an enriched understanding of psychological functioning.

Relationships between God and people in the Bible, part III: When the other is an outsider.

This study considers intergroup attitudes in the Bible and compares relationships between God or Jesus and (a) Torah non-Israelites; (b) New Testament people who were not followers of Jesus; and (c) New Testament people who were not Jewish. Torah non-Israelites belonged to an out-group with respect to the Hebrew Torah, New Testament people who were not followers of Jesus belonged to an out-group with respect to the Christian New Testament, and New Testament people who were not Jewish were an in-group with respect to Christians. Results were that God or Jesus' relationships were very negative with people in the Torah who were non-Israelites and with people in the New Testament who were not followers, while relationships were positive with people in the New Testament who were not Jewish. Thus, in conclusion, results indicate that both the New Testament and the Torah portray negative relationships between God or Jesus and members of out-groups. Relationships portrayed in New Testament narratives about God and people who were not followers were sometimes more negative than observed for other groups in the New Testament and the Torah; for people who were viewed as outsiders, the New Testament could sometimes be more negative than the Torah. An aim of this study was to identify patterns of relationships between God or Jesus and different types of people in narratives of the Torah and in the New Testament. One of the characteristics of different types of people, including people described in biblical narratives, is whether they are members of in-groups or out-groups. Our focus in this report is on biblical narratives about people who are members of out-groups. The results contribute a clinical-quantitative assessment of out-groups in the Torah and New Testament that is focused on relationship with God, a central issue in the psychology of religion and the Bible.

A method of choosing CCRT scorers.

This study compared interjudge agreement in 2 sample cases in which both experienced as well as inexperienced scorers were used. Scorers were given only a single page of core conflictual relationship theme (CCRT) instructions to help them learn the method. The results in both cases suggest that there was significantly greater interjudge agreement among experienced CCRT scorers compared with inexperienced scorers.

Is psychotherapy good for your health?

This is a dedicated review of the evidence for the relation of having a period of psychotherapy and then comparing it with a measure of improved physical health. We aimed to make it the first intended-to-be-complete review of this type. Three inter-related types of studies were examined: Type 1: reduction in physical illnesses through psychotherapy, especially for the patient's survival time during the interval between diagnosis and an end point, Type 2: reduction in pain in relation to receiving psychotherapy, and Type 3: reduction in costs of treatment in relation to receiving psychotherapy. To find the relevant studies on these topics, we performed a literature search using both Psychinfo and Medline databases. An average of the effect sizes under each type was taken to calculate the mean effect size along with its confidence interval. Our results (1) on survival time for the combined severe patients, did not reach even the lowest significant level of effect size, although the low severity patients seemed to fit the hypothesis better, but the other two reduction topics, (2) and (3), clearly did achieve it.

Relationships between God and people in the Bible, Part II: The New Testament, with comparisons with the Torah.

IN AN EARLIER study on the first five books of the Bible, the Torah or Pentateuch, relationships between God and people were assessed with the use of a clinical-quantitative method, the core conflictual relationship theme (CCRT) method. Here, the study is extended to God or Jesus's relationships with people in the New Testament, to obtain the first description of those relationships based on an established measure of relationships. In the New Testament, many different kinds of relationship themes were observed, with benevolent and positive themes as the most frequent. Other results included that: (a) relationships in the New Testament often appeared more positive than in the Torah; (b) New Testament relationships between Jesus and people were less positive than between God and people; and (c) God's relationship with Jesus was more positive than God's relationship with Moses. Relationships with Paul, Peter, and women were also assessed. Relationship patterns were considered within the context of attachment theory, and biblical CCRT patterns were consistent with depiction of both secure and anxious attachments. Biblical relationships portray a variety of models for interpersonal relationships, ranging from the very positive to the very negative.

The Same Old Song?-Stability and Change in Relationship Schemas From Adolescence to Young Adulthood.

Relationship schemas are core elements of personality that guide interpersonal functioning. The aim of this study is to examine stability and change in relationship schemas across two developmental epochs-adolescence and young adulthood-in the stories that people tell about their interactions with others. Using the Core Conflictual Relationship Theme Method, relationship themes were coded from semistructured interviews conducted in adolescence and again at age 25. The sample consisted of 40 participants in a longitudinal study of adolescent and young adult psychological development. There was considerable stability in the frequency with which particular themes were expressed in the narratives of adolescents and young adults. Significant changes from adolescence to young adulthood included a decrease in the perception of others as rejecting and of the self as opposing others. Young adults saw themselves and others more positively, and used a broader repertoire of themes in their relationship narratives than they had as adolescents. The basic continuity and particular changes in relationship schemas found in this study are consistent with knowledge about the adolescent-to-young-adult transition derived from other empirical and clinical findings. Relationship schemas may be rich units of study for learning about the development of interpersonal functioning.