In-session interactive dynamics of the psychotherapy process between therapeutic alliance, therapist expertise, therapist technical intervention, patient metacognition and functioning.

Empirical research has explored different dimensions of the therapy process and their associations, often showing bidirectional links: for example, metacognition may be favoured by a positive alliance with the clinician; on the other hand, metacognitive difficulties may be an obstacle for the alliance. However, little is still known about the overall relationship between multiple dimensions during the psychotherapy process. The aim of this study is to further explore the in-session interaction of therapeutic process variables, focusing on patient metacognition, therapeutic alliance, technical intervention, therapist expertise, and patient functioning. Participants included 45 patients involved in a psychodynamic weekly treatment in two clinical centres. Therapists were both in-training and experienced clinicians. Four instruments were applied on four psychotherapy sessions (178 verbatim transcripts): Metacognition Assessment Scale-Revised (MAS-R) assessing metacognition, Collaborative Interaction Scale (CIS) assessing therapeutic alliance, Psychodynamic Intervention Rating Scale (PIRS) assessing therapist technical interventions, and Shedler-Westen Assessment Procedure (SWAP)-200 assessing patient functioning. Sequential analyses revealed that specific therapist interventions co-occurred with three different levels of therapeutic alliance: a first one characterized by positive collaboration, the second one by neutral collaboration, and the third one by ruptures. Moreover, and critically, the patient metacognition, patient functioning, and therapist expertise were found to exert different effects in the three alliance levels. These findings suggest the existence of a specific interdependence between the variables involved in the research. These results further indicate that the therapist expertise is a key element in the therapeutic process, as it can drastically affect the in-session interactive dynamic.

An Online Tool to Assess Sentence Comprehension in Teenagers at Risk for School Exclusion: Evidence From L2 Italian Students.

This study presents a web-based sentence comprehension test aimed at identifying high school students who are at risk for a language delay. By assessing linguistic skills on a sample of high school students with Italian as an L2 and their monolingual peers, attending a vocational school, we were able to identify a subgroup of L2 students with consistent difficulties in sentence comprehension, though their reading skills were within the average range. The same subgroup revealed to experience a lack of support within the school context, suggesting that poor L2 skills might be a critical variable to consider in order to identify students at risk for school exclusion. Regarding the test, accuracy to the on-line sentence comprehension task was significantly predicted by reading abilities and vocabulary skills, thus indicating that this test might represent a rapid but efficient way to assess linguistic abilities at school. We recommend that establishing a valid and practical procedure for the evaluation of linguistic skills in bilingual students who struggle with their L2 is the first step toward promoting social inclusion in the multilingual classroom, in order to increase their ability to actively participate in school and social activities.

Cognitive Profile of Intellectually Gifted Adults: Analyzing the Wechsler Adult Intelligence Scale.

The Wechsler Adult Intelligence Scale (WAIS) has been used extensively to study intellectual abilities of special groups. Here, we report the results of an intellectually gifted group on the WAIS-IV. Gifted individuals are people who obtained scores equal to or greater than 2 standard deviations above the mean on an intelligence test. Hence, the current study aims first, to examine mean group performance data of gifted individuals on the WAIS-IV; second, to revalidate the pattern of performance identified in this special group in previous studies (i.e., verbal skills higher than all other abilities); third, to compare scatter measures across intellectual domains with a matched comparison group. A total of 130 gifted individuals (79 males) were administered the full battery and their performance was compared with a matched comparison group. Analyses revealed that gifted group displayed higher scores in all intellectual domains. Contrary to expectations, they showed the highest scores in perceptual reasoning tasks. A multivariate approach revealed that this ability was statistically different from all other domains within the gifted group. Moreover, gifted individuals showed higher discrepancies across intellectual domains than average-intelligence people. Findings have important practical implications to detect intellectual giftedness in adulthood.

The flip side of collaborative alliance: a single-case study.

The present single case study explored whether a positive collaboration may conceal some of the patient's dysfunctional interpersonal schemas, hence reflecting a non-authentic collaboration. In particular, we reasoned that conceiving collaborations only as adaptive relations may prevent a comprehensive insight of the therapeutic relationship itself. To explore this possibility, we used an intersubjective approach that emphasizes the integration of specific and non-specific factors in an interdependent way. In particular, we assessed different constructs (i.e. therapeutic alliance, technical interventions, defense mechanism, therapeutic relationship) of the therapeutic process and combined them through statistical methods able to investigate the micro- and macro-analytic processes that define each interaction. Results of a single case study (Sara) showed that the collaborative functioning may hold back many critical aspects, that hardly conciliate with the classic positive definition of collaboration. These findings, therefore, indicate that Sara's collaborative alliance works mainly as a pseudo-alliance.

Assessing Narcissism Using Rorschach-Based Imagery and Behavior Validated by Clinician Reports: Studies With Adult Patients and Nonpatients.

We evaluate 11 Rorschach variables with potential for assessing grandiosity and narcissism. Seven of these variables were drawn from previous literature: Omnipotence, Idealization, Reflection, Personal Knowledge Justification, Exhibitionism, Magic, and Elevated Mood States; four were developed for this research: Expanded Personal Reference, Narcissistic Devaluation, Narcissistic Deflation, and Narcissistic Denial. Using Rorschach protocols from American normative adults and Italian adult outpatients, the dimensional structure of these variables was evaluated by principal components analysis, and validity was tested by correlations with clinician ratings of narcissism on two scales from the Shedler-Westen Assessment Procedure-200 that were made after at least five sessions with the primary clinician. A cohesive dimension was found in both data sets defined by Expanded Personal Reference, Personal Knowledge Justification, Omnipotence, and Idealization, and it was meaningfully correlated with the clinician ratings of narcissism ( M r = .41). Implications of the findings include the applicability of these variables in clinical practice and research for assessing narcissistic personality dynamics.

The coconstruction of interpersonal recognition in the clinical dialogue of the diagnostic process: A multilevel analysis of the verbal content and vocal nonverbal dimension.

The present study is an empirical evaluation of a clinical setting from a particular point of view, able to integrate the vocal dimension-used in different fields of psychology as an indicator of rational phenomena-with the linguistic dimension of contents. Starting from the "interpersonal recognition" extracted from the contents of the verbatim transcripts of some diagnostic processes using the Strumento di Valutazione del Riconoscimento Interpersonale (Evaluation Tool for Interpersonal Recognition), the variation of vocal parameters both in the clinician and in the patient were analyzed. The goal consists in identifying possible nonverbal vocal micro indicators used in the dyadic process of interpersonal recognition. Specific and bidimensional nonverbal vocal patterns and strategies are hypothetically matched with different efficacy levels of recognition, both for the clinician and the patient.

Diagnostic Agreement Between Clinicians and Clients: The Convergent and Discriminant Validity of the SWAP-200 and MCMI-III Personality Disorder Scales.

A particularly controversial aspect in the field of personality assessment is the use of self-report measures, versus clinicians' evaluations, for diagnosing personality disorder (PD). No studies have systematically documented the agreement between these sources for the entire array of DSM-5 PDs using comprehensive measures and experienced clinicians' judgments. The present work fills this gap by indexing the agreement between patients' self-descriptions and clinicians' judgments, relying on standardized and thorough PD instruments. The Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 1999b) and the Millon Clinical Multiaxial Inventory-III (Millon, Davis, & Millon, 1997) were both completed in a clinical series of 56 adult outpatients. Analyses highlighted moderate correlations between the two measures for the 10 DSM-5 PDs (Mdn = .35). Agreement was highest for psychological features that are more easily observable by the clinicians. Furthermore, results revealed problematic discriminant validity between the two instruments.

Cross-Cultural Validation of the Rorschach Developmental Index.

The Developmental Index (DI) has recently been introduced as a composite Rorschach measure of psychological development and maturation, which can be used both with the Comprehensive System (Exner, 2003), and with the recently developed Rorschach Performance Assessment System (Meyer, Viglione, Mihura, Erard, & Erdberg, 2011). As the DI is new, and its validity has not yet been investigated with independent non-U.S. samples, we tested the correlation between DI and age using 3 relatively large samples, 2 of which were from outside the United States (total N = 902). Other Rorschach variables presumably associated with maturation, such as complexity and productivity, were also investigated. As expected, the DI significantly correlated with age, with small variations across the 3 samples. Importantly, the correlation between DI and age remained statistically significant also after controlling for productivity (i.e., the number of responses) and complexity.

[Kennedy V Axis assessment in an Italian outpatient and inpatient population]. / L'applicazione dell'Asse V di Kennedy a un campione clinico italiano.

INTRODUCTION: Kennedy Axis V or K Axis acts is an alternative tool to the DSM-IVTR Global Assessment of Functioning (GAF) Scale, that many researchers describe as a scale with poor inter-rater reliability and clinical utility. Unlike the GAF scale, K Axis provides a multidimensional and multiaxial approach to measure personal, social and interpersonal functioning in psychiatric outpatients and inpatients. In this study, we examined K Axis's inter-raters reliability by using it with an Italian clinical population. METHODS: Clinicians used Kennedy Axis V to assess global functioning among 180 inpatients, in 9 psychiatric services in Lombardia and Piemonte. Patients were divided into 4 different diagnostic groups, according to the DSM-IV-TR criteria. RESULTS: Intraclass correlations between two independent raters's scores reveal high level of interrater reliability for all K Axis scales (0,633 < ICC < 0,813). Highly significant results in the Kruskal-Wallis test demonstrate that the patient diagnosis influence all the scales scores. Significant differences in patients functioning profiles in all K Axis scales, apart from Violence one, were noted between different diagnosis groups. CONCLUSIONS: In this study high level of raters agreement was noted, even if K Axis scales were used in different mental health services from different clinicians. K Axis scales provide a useful profile of patient global functioning, in line with the specific pathology.