Bart Vandeneede

Process and outcome in psychodynamic hospitalization-based treatment for patients with a personality disorder.

This study examined the relationship between the psychotherapeutic process and outcome in 44 patients who completed hospitalization-based psychodynamic treatment for personality disorders. Using self-report and interview ratings, outcome was assessed in terms of symptoms and personality functioning, and the psychotherapeutic process in terms of self and object relations, felt safety, and reflective functioning. Symptom and process measures were administered at intake, every 3 months during treatment, and at 3 and 12 months follow-up. Personality measures were collected at intake, the end of treatment, and at 3 and 12 months follow-up. Using Piecewise Linear Growth Curve Analysis results showed improvement in symptoms, personality functioning, self and object relations and felt safety, but not in reflective functioning. Linear changes in self and object representation and felt safety, but not in reflective functioning, predicted improvement in outcome.

Outcome and Outcome Trajectories of Personality Disordered Patients During and After a Psychoanalytic Hospitalization-Based Treatment

This study aims to identify different outcome trajectories in a psychoanalytic hospitalization-based treatment in a sample of 70 patients with personality disorders using a naturalistic 12 month follow-up design. Trajectory analysis identified four groups of patients, i.e., patients showing (a) high initial symptom levels and considerable and consistent improvement late in treatment (High-Low group; HL), (b) medium initial symptom levels and a quick and sustained response (Medium-Low group; ML), (c) medium initial symptom levels but without substantial improvement (Medium-Medium group; MM), and (d) low initial symptom levels without substantial further improvement during and after treatment (Low-Low group; LL). Further, data suggested that these four trajectories were related in theoretically meaningful ways to pre-treatment variables, such as anaclitic and introjective personality styles and trauma. Results are discussed in the context of other studies showing the need for differential treatment approaches based on pretreatment characteristics.

LEVELS OF PERSONALITY FUNCTIONING AND THEIR ASSOCIATION WITH CLINICAL FEATURES AND INTERPERSONAL FUNCTIONING IN PATIENTS WITH PERSONALITY DISORDERS

Recently, the DSM-5 Personality and Personality Disorders Work Group has proposed a multiple level approach toward the classification and diagnosis of personality disorders (PDs), with the first level entailing a rating of impairments in levels of personality functioning. Although a number of measures that assess levels of personality functioning have been validated, given its prominent status in the DSM-5 proposal and contemporary theories of personality pathology, the Work Group has called for more research in this area (e.g., Bender, Morey, & Skodol, 2011). In response to this call, this study investigates the relationship between two major, well-validated dimensional measures of levels of personality functioning, that is, the Differentiation-Relatedness Scale (DR-S; Diamond, Blatt, Stayner, & Kaslow, 1991), as scored on the Object Relations Inventory (ORI; Blatt, Wein, Chevron, & Quinlan, 1979), and the Inventory of Personality Organization (IPO; Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001), a self-report instrument, and their relationship with different measures of clinical and interpersonal functioning in 70 patients with a PD. First, results showed that higher levels of differentiation and relatedness of descriptions of self and significant others, and of the self in particular, were negatively related to indices of personality functioning as assessed by the IPO. Lower levels of personality functioning, as measured with both the DR-S and the IPO, were positively related to severity of depression, symptomatic distress, self-harm, and interpersonal problems. Finally, results showed that the DR-S and the IPO independently predicted clinical features and interpersonal functioning. Hence, this study lends further support for the concurrent and predictive validity of the DR-S and the IPO in assessing levels of personality functioning. However, more research concerning the validity of these measures in assessing levels of personality functioning is needed. Suggestions for further research are formulated.

Patterns of inner change and their relation with patient characteristics and outcome in a psychoanalytic hospitalization‐based treatment for personality disordered patients

This study investigated whether different clusters of patients with personality disorders in a psychoanalytic hospitalization-based treatment were associated with: (a) different changes in personality organization (PO); (b) different pre-treatment variables; and (c) different associations between changes in PO and outcome. K-means clustering analysis identified two clusters of patients, which showed different changes in PO and mainly differed in terms of levels of anaclitic and introjective personality features, respectively. Both clusters showed a significant decrease in symptoms and an improvement in personality functioning during treatment and at 3-month follow-up. Clinical implications of these findings are discussed.

A psychoanalytically informed hospitalization‐based treatment of personality disorders

This study presents a model of psychic change in personality disorders focusing on three dimensions: felt safety, mentalization and self‐object relations. Based upon this model a hospitalization‐based therapy program was created. Four scales to measure these three dimensions on the Object Relation Interview are discussed: the Felt Safety Scale, the Reflective Functioning Scale and the Bion Grid Scale and the Differentiation‐Relatedness Scale. A naturalistic symptom outcome study of the program showed a large effect on both symptoms and personality functioning. Furthermore, trajectory based on pre‐treatment patient characteristics (i.e., anaclitic versus introjective personality styles). Importantly, we also found a relation between symptomatic and personality change and change in felt safety and object relations. At 5‐year follow‐up, patients showed sustained improvement in symptomatic distress and further improvement in terms of personality and interpersonal functioning.

Predictors of Dropout From a Psychodynamic Hospitalization-Based Treatment for Personality Disorders.

Today, psychotherapy is the treatment of choice for patients with a personality disorder (PD). PD patients are however difficult to engage into treatment and little is known about the factors that lead to dropout. The aim of this study was to increase our understanding of dropout in PD patients. In particular, and based on earlier studies, we aimed to identify baseline patient factors predicting dropout from a psychodynamic hospitalization-based treatment program. Results in a sample of 129 well-screened PD patients showed (a) a dropout rate of 34%, which is in line with earlier studies; (b) univariate analysis indicated that a lower educational level, the presence of Cluster A PD, especially schizoid PD, the total number of Axis II disorders, and the total number of Axis I disorders were predictive of dropout; and (c) when these variables were entered in a stepwise logistic regression analysis, the only significant predictor of dropout was the number of Axis II diagnoses. Dropout from a hospitalization-based psychodynamic treatment program was thus associated with a higher number of Axis II diagnoses (odds ratio = 1.73, 95% confidence interval [1.16, 2.57]). These findings suggest that the more serious one’s personality pathology is at the start of treatment, the higher the chance patients will drop out from our treatment program. Implications for the psychosocial treatment of PD patients are formulated.

Un tratamiento de desórdenes de la personalidad psicoanalíticamente informado basado en hospitalización

Este estudio presenta un modelo de cambio psíquico en los desórdenes de la personalidad en tres dimensiones: sensación de seguridad, mentalización y relaciones auto-objetales. Basado en este modelo, se creó un programa de hospitalización basado en terapia. Se tratarán cuatro escalas para medir estas tres dimensiones sobre la Entrevista de la Relación Objetal para ser discutidas: la escala de la sensación de seguridad, la escala del funcionamiento reflexivo, la escala de la Tabla de Bion y la escala de la Relación Diferenciada. El resultado de un estudio de síntoma naturalista del programa mostró un importante efecto. Finalmente, el análisis de la trayectoria mostró diferentes tipos relacionados con las características del paciente al comienzo del tratamiento de acuerdo con el estilo de la personalidad analítico/introyectiva (Blatt, 2008). El cambio psíquico interno de los pacientes se estudió con las cuatro escalas y quedaron demostrados dos grupos. Lo más importante del resultado que encontramos fue una correlación del nivel del síntoma con el cambio interno psíquico. Más adelante presentamos el seguimiento de un estudio de 5 años sobre la muestra del mismo paciente que refleja una mejoría sostenida en las escalas del síntoma clínico y un posterior progreso en las escalas de la personalidad.