Annalisa Tanzilli

Patient Personality and Relational Patterns in Psychotherapy: Factor Structure, Reliability, and Validity of the Psychotherapy Relationship Questionnaire

ABSTRACT The aim of this study was to examine the factor structure and the psychometric properties of the Psychotherapy Relationship Questionnaire (PRQ; Bradley, Heim, & Westen, 2005), a clinician report instrument that measures a wide spectrum of thoughts, feelings, motives, conflicts, and behaviors expressed by patients toward their therapists in psychotherapy. A national sample of psychiatrists and clinical psychologists (N   = 314) of different theoretical orientations completed the PRQ, as well as the Shedler–Westen Assessment Procedure–200 (SWAP–200; Westen & Shedler, 1999a, 1999b) to assess the personality of a patient in their care. Factor-analytic procedures identified 6 transference dimensions that showed excellent internal consistencies: (a) hostile, (b) positive/working alliance, (c) special/entitled, (d) anxious/preoccupied, (e) avoidant/dismissing attachment, and (f) sexualized. Factor scores were significantly related to patients’ personality characteristics and psychological functioning, regardless of the clinicians’ orientations. The findings support that the PRQ is a valid and reliable tool for evaluating the patients’ relational patterns emerging in clinical practice in a clinically coherent and psychometrically robust way. Clinicians’ careful understanding of these patterns can be very useful for making accurate diagnostic formulations, as well as for providing a roadmap for effective therapeutic intervention.

Countertransference when working with narcissistic personality disorder: An empirical investigation.

Narcissistic personality disorder (NPD) is one of the most challenging clinical syndromes to treat in psychotherapy, especially due to the difficulties of establishing a good enough therapist–patient relationship. Countertransference responses to NPD can be particularly intense, frustrating, and difficult to manage, as is often reported in the clinical literature though not clearly supported empirically. The aims of this study were to (a) investigate the relationship between patients’ NPD and therapists’ responses; (b) examine the associations between patient, clinician, therapy variables and clinicians’ reactions during treatment of NPD patients; and (c) provide an empirically derived portrait of countertransference with NPD. A sample of psychiatrists and clinical psychologists (N = 67) completed the Therapist Response Questionnaire to identify patterns of countertransference, the Shedler–Westen Assessment Procedure-200, and the Global Assessment of Functioning Scale to assess the personality pathology and psychosocial functioning of a patient in their care. The results showed that NPD was positively associated with hostile/angry, criticized/devalued, helpless/inadequate, and disengaged countertransference and negatively associated with therapists’ positive response, regardless of patients’ personality and psychosocial functioning. NPD patients with stronger traits of cluster B personality pathology tended to elicit more negative and heterogeneous countertransference reactions than NPD patients without these features. The countertransference patterns with NPD patients were not strongly influenced by the variables of clinicians and therapy, with the exception of clinical experience. Overall, the portrait of therapists’ reactions to NPD provided a clinically nuanced and empirically founded description strongly resembling theoretical–clinical accounts. The therapeutic implications of these findings were discussed.

Psychotherapy research and the Psychodynamic Diagnostic Manual (PDM–2).

The new Psychodynamic Diagnostic Manual (PDM-2; Lingiardi & McWilliams, 2017) aspires to emphasize a holistic view of individuals, rather than focusing solely on the treatment of diagnoses or the amelioration of symptoms that constitute them. In this paper, we discuss the ways in which the PDM-2 differs from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM–5; American Psychiatric Association, 2013) and complements it as a tool. We discuss these topics in the context of studies within the field of psychotherapy research that seem to be relevant to PDM-2 syndromes and domains of functioning. We review some recent specific examples of psychotherapy research that help illustrate the role that different PDM-2 constructs play in treatment, as well as suggest ideas for future directions in research about the PDM-2. It is our hope that the PDM-2 diagnostic framework will aid in planning clinically sophisticated and methodologically robust research designs examining psychotherapy process and outcome.

Attitude toward Christianity, sexual orientation, and parental religiosity in a sample of Italian adolescents

Abstract Literature suggests that several demographic variables are linked with religiosity in adolescence, such as gender, age and parental religiosity. The sample consisted of 910 young people (53% female) between 14 and 19 years of age, attending secular secondary schools in Rome, Italy. They self-identified as heterosexual adolescents (91.6%), and lesbian/gay (LG) adolescents (8.4%). High scores of positive attitudes toward God, Jesus, the Bible, prayer and church were associated with female gender, higher father’s religiosity, and higher mother’s religiosity, but not with age of the participants. As expected, heterosexual orientation was associated with a more positive attitude toward Christianity, controlling for sex, age, and parental religiosity.

Social Contact, Social Distancing, and Attitudes Toward LGT Individuals: A Cross-Cultural Study of College Students in the United States, Italy, and Spain

ABSTRACT More than any other time in modern history, today people are significantly more likely to know (or be) lesbian, gay, and transgender (LGT) people; however, prejudices directed toward these groups remain. In the current study, we explore how social contact and social distancing/desired social contact are related to LGT prejudices using Worthen’s (2012) Attitudes Toward LGT People Scales and data from four heterosexual college student samples in Oklahoma, Texas, Italy, and Spain (N = 1,217). In doing so, we provide the first-ever study to explore Allport’s (1954) contact hypothesis as it relates to transgender prejudices in Italy and Spain and the first study to examine desired social contact/social distancing and transgender prejudice in the U.S., Italy, and Spain. Our findings demonstrate that measures of desired social contact are strongly related to cross-cultural LGT attitudes, while simple measures of contact (i.e., knowing an LGT person) are significantly less robust.

Patient SWAP-200 Personality Dimensions and FFM Traits: Do They Predict Therapist Responses?

The main aim of this study was to examine the relationship between therapists’ emotional responses and patients’ personality evaluated by 3 dimensional diagnostic approaches empirically derived from the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 1999b): Two of these rely on the 5-factor model (FFM) domains, that were assessed with different SWAP-200 FFM versions developed by Shedler and Westen (SW-FFM scales; 2004) and McCrae, Löckenhoff, and Costa (MLC-FFM scales; 2005); the third approach is based on a multifaceted model of personality syndromes (SWAP personality dimension scales; see Shedler & Westen, 2004). A national sample of psychiatrists and psychologists (N = 166) of various theoretical orientations completed the Therapist Response Questionnaire (TRQ; Zittel Conklin & Westen, 2003) to identify patterns of therapist response, and the SWAP-200 to assess personality regarding a patient currently in their care. The findings showed good levels of construct validity between the SW-FFM and MLC-FFM scales, with the exception of the Openness trait. Moreover, specific SW-FFM and MLC-FFM scales were significantly associated with distinct SWAP personality dimension scales according in a conceptually meaningful nomological network. Although there were significant, theoretically coherent, and systematic relationships between therapists’ responses and patients’ personality features, overall the contribution of the SW-FFM and MLC-FFM traits in predicting therapists’ responses was less sizable than the SWAP personality dimensions. These results seem to confirm the diagnostic and therapeutic value of countertransference as an essential tool in understanding psychological traits/dimensions that underlie the patients’ psychopathology, both from within and outside of the FFM.