Kenneth L. Critchfield

Structured Interview of Personality Organization (STIPO): preliminary psychometrics in a clinical sample.

In this article, we describe the development and preliminary psychometric properties of the Structured Interview of Personality Organization (STIPO), a semistructured interview designed for the dimensional assessment of identity, primitive defenses, and reality testing, the three primary content domains in the model of personality health and disorder elaborated by Kernberg (1984; Kernberg & Caligor, 2005). Results of this investigation, conducted in a clinical sample representing a broad range of personality pathology, indicate that identity and primitive defenses as operationalized in the STIPO are internally consistent and that interrater reliability for all 3 content domains is adequate. Validity findings suggest that the assessment of ones sense of self and significant others (Identity) is predictive of measures of positive and negative affect, whereas the maladaptive ways in which the subject uses his or her objects for purposes of regulating ones self experience (Primitive Defenses) is predictive of measures of aggression and personality disorder traits associated with cluster B personality disorders. We discuss implications of these findings in terms of the theory-driven and trait-based assessment of personality pathology.

Internalized Representations of Early Interpersonal Experience and Adult Relationships: A Test of Copy Process Theory in Clinical and Non-Clinical Settings

Abstract Studies connecting childhood experience and adult psychopathology often focus on consequences of abuse and neglect. Copy process theory (Benjamin, 2003) states that constructive as well as destructive experiences shape adult behavior with surprising interpersonal specificity. Childhood perceptions and social learning are encoded in memory and then “copied” in 3 basic ways in subsequent relationships: Identification (behaving as he or she behaved), Recapitulation (behaving as one behaved when with him or her), and Introjection (treating oneself as he or she was treated). The first step in evaluating copy process theory is to verify that the predicted correspondence between adult relational patterns and internal representation of early experience can be observed in different adult samples. Remembered interpersonal patterns from childhood and perceptions of adult relational patterns were measured using the Structural Analysis of Social Behavior (SASB). Strong evidence was found for each copy process in a sample of psychiatric inpatients (N = 161) and a college sample (N = 133). Positive and negative behaviors were copied in both. Evidence suggests that gender, patient status, and rated state may influence whether, and in which forms, copying occurs.

Assessment of Repeated Relational Patterns for Individual Cases Using the SASB-Based Intrex Questionnaire

Repeated interpersonal patterns are central to case conceptualization and treatment planning in interpersonal and attachment-based approaches to therapy. In this study, raters (133 college students, 165 inpatients) provided data on the Intrex questionnaire (Benjamin, 2000) about self-treatment, relationship with a significant other, and remembered interactions with parents in childhood. Within-subject profiles were inspected for precise behavioral matches conforming to 3 “copy process” (CP) patterns: identification (behaving like an important other), recapitulation (behaving as if the other person is still present and in charge), and introjection (treating the self the way another did). We observed CP evidence in most individual ratings. Consistent with expectation, nonclinical raters tended to copy a securely attached pattern of affiliation, low hostility, and moderate degrees of enmeshment and differentiation. Only patients copied maladaptive behavior at greater than base rate expectation. We discuss implications and provide recommendations for use of Intrex in individual assessment of CP.

Affiliation and Control in Marital Interaction Interpersonal Complementarity Is Present but Is Not Associated With Affect or Relationship Quality

The principle of complementarity in interpersonal theory states that an actor’s behavior tends to “pull, elicit, invite, or evoke” responses from interaction partners who are similar in affiliation (i.e., warmth vs. hostility) and opposite in control (i.e., dominance vs. submissiveness). Furthermore, complementary interactions are proposed to evoke less negative affect and promote greater relationship satisfaction. These predictions were examined in two studies of married couples. Results suggest that complementarity in affiliation describes a robust general pattern of marital interaction, but complementarity in control varies across contexts. Consistent with behavioral models of marital interaction, greater levels of affiliation and lower control by partners—not complementarity in affiliation or control—were associated with less anger and anxiety and greater relationship quality. Partners’ levels of affiliation and control combined in ways other than complementarity—mostly additively, but sometimes synergistically—to predict negative affect and relationship satisfaction.

Transference interventions and the process between therapist and patient.

Interpreting the transference has been considered a core ingredient in psychodynamic psychotherapy. The effects of analyzing the transference are probably dependent on certain characteristics of the interventions themselves and the context in which transference interventions are given. The present study describes the development and use of a therapy process rating scale (Transference Work Scale; TWS) constructed to identify, categorize, and explore work with the transference. TWS has subscales that rate timing, content, and valence of the transference interventions, as well as response from the patient. Transcribed segments (10 min) from 51 different patients were scored with TWS by 2 independent raters. The interrater agreement on the TWS items was good to excellent. Clinical examples of transference work were also rated using the Structural Analysis of Social Behavior (SASB). TWS and SASB supplement each other. TWS might be a potentially useful tool to explore the interaction of timing, category, and valence of transference work in predicting in-session patient response as well as treatment outcome.

Tailoring common TreaTmenT principles To fiT individual personaliTies

The American Psychological Association Task Force headed by Castonguay and Beutler (2006) distilled general treatment principles common to all therapies from the empirical literature. As part of this work, Critchifield and Benjamin (2006a, 2006b) summarized principles for treatment of personality disorder. The principles are pragmatic in the sense that they are based on evidence of what works, and clinicians are encouraged to apply them in ways that fit the unique presentation and needs of a given patient. An important element of the recommended approach is that it be coherent, well-coordinated, and agreed upon by the patient. Additional principles emphasize the importance of an individuals attachment and trauma history. A complex case example is presented to illustrate one way in which emphasis on an individuals relational learning history can be used to further refine and extend wisdom inherent in the cross-cutting principles and move in the direction of an integrative treatment that is closely tailored to specific case features. A research approach is also outlined for how to test the validity of principles that prescribe differential use of technique to address diverse patient presentations.

A Prototypical Profile of Borderline Personality Organization Using the Structured Interview of Personality Organization (STIPO)

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Reliability, Sensitivity, and Specificity of Case Formulations for Comorbid Profiles in Interpersonal Reconstructive Therapy: Addressing Mechanisms of Psychopathology

Interpersonal Reconstructive Therapy (IRT) case formulations describe psychosocial mechanisms of affective and personality pathology in ways that enhance the effectiveness of psychotherapy for individuals. With a valid and reliable IRT case formulation, a clinician is in a better position to draw upon effective techniques to maximize treatment effects. The case formulation and treatment models for IRT were described in depth along with the IRT treatment model by Benjamin (2003/2006). Data in this report from 93 adult inpatients with complex and comorbid presentations suggest that the case formulation is highly reliable and unique to individuals, and that symptoms reflect current interpersonal stresses linked to early interactions involving forms of hostility in relation with attachment figures and corresponding to three basic patterns in adulthood: identification (be like him or her), recapitulation (act as you did with him or her), and introjection (treat yourself as you were treated).

Characterizing the integration of CBT and psychodynamic techniques in interpersonal reconstructive therapy for patients with severe and comorbid personality pathology.

A “unifying” approach to psychotherapy integration (Magnavita & Anchin, 2014) uses a metatheoretical framework to delineate mechanisms of psychopathology and change that cut across traditional theoretical orientations. Interpersonal Reconstructive Therapy (IRT; Benjamin, 2006, in press) is 1 such approach to treatment. In IRT, therapists view clinical symptoms and problems as natural consequences of maladaptive interpersonal patterns related to safety and threat that patients have learned and internalized in the context of close attachment relationships. Therapists may use interventions from any tradition so long as use is consistent with the individual patient’s case formulation and underlying treatment principles. Prior work has suggested that adherence to IRT principles, particularly a focus on internalized attachments, has strong links to retention and outcome (Critchfield et al., 2011). In the present work, 19 outpatient IRT sessions were sampled from a research archive of therapies conducted with complex cases identified as comorbid, often rehospitalized, dysfunctional, and suicidal (CORDS). Included were 9 sessions showing high adherence to IRT principles and 10 contrasting low adherence sessions. Trained raters applied the Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman, Bonge, & Blais, 2005). As expected, adherent IRT sessions contained both psychodynamic–interpersonal and cognitive–behavioral techniques in ways that reflected integrative theory. Less expected was that rater reliability in identifying standard techniques varied systematically as a function of IRT adherence. This last finding has broad implications for psychotherapy integration research, especially with principles-based, unified models. Caracterización de la Integración de la Teraria Cognitiva Conductual y Técnicas Psicodinámicas en la Terapia Reconstructiva Interpersonal para Pacientes con Patología de la Personalidad Grave y Comórbida Un enfoque “unificador” para la integración de la psicoterapia (Magnavita & Anchin, 2014) utiliza un marco metatoreórico para delinear mecanismos de psicopatología y cambio que recorren las orientaciones teóricas tradicionales. La Terapia Reconstructiva Interpersonal (IRT, Benjamin, 2006, en prensa) es una de esas aproximaciones al tratamiento. En IRT, los terapeutas consideran los síntomas y problemas clínicos como las consecuencias naturales de los patrones interpersonales desadaptativos relacionados con la seguridad y la amenaza que los pacientes han aprendido e interiorizado en él contexto de relaciones de apego estrechas. Los terapeutas pueden utilizar intervenciones de cualquier tradición siempre y cuando el uso sea consistente con la formulación del caso del paciente individual y los principios de tratamiento subyacentes. Trabajos anteriores han sugerido que la adhesión a los principios del IRT, particularmente un enfoque en los anexos internalizados, tiene fuertes vínculos con la retención y el resultado (Critchfield et al., 2011). En el presente trabajo, 19 pacientes ambulatorios fueron tomados de un archivo de investigación de tratamientos realizados con casos complejos identificados como comórbidos, a menudo rehospitalizados, disfuncionales y suicidas (CORDS). Se incluyeron 9 sesiones que mostraron alta adherencia a los principios de IRT y 10 sesiones de baja adherencia contrastantes. Los evaluadores entrenados aplicaron la Escala de Procesos de Psicoterapia Comparativa (CPPS, Hilsenroth et al., 2005). Como era de esperar, las sesiones de IRT adherentes contenían tanto técnicas psicodinámicas-interpersonales como cognitivas-conductuales de maneras que reflejaban la teoría integradora. Menos esperado fue que la fiabilidad del evaluador en la identificación de técnicas estándar varió sistemáticamente como una función de la adhesión al TRI. Este último hallazgo tiene amplias implicaciones para la investigación de integración de la psicoterapia, especialmente con modelos unificados basados en principios.