Kevin B. Meehan

Measuring Reflective Function With a Multidimensional Rating Scale: Comparison With Scoring Reflective Function On the Aai:

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The relationship between effortful control, current psychopathology and interpersonal difficulties in adulthood.

This study examined whether the relationship between low effortful control (EC), general psychopathology and interpersonal maladjustment previously reported among children extends to adulthood. Two hundred and forty undergraduate students were assessed using the EC scale of the Adult Temperament Questionnaire, the General Severity Index of the Brief Symptom Inventory (BSI-GSI) and the interpersonal distress index of the Inventory of Interpersonal Problems-Short Circumplex (IIP-distress). Both the BSI-GSI and the IIP-distress scores were related to low levels of EC. Furthermore, interpersonal distress mediated the association between low EC and greater psychopathology severity. These results suggest that deficits in regulatory temperament among adults may be associated with experiencing greater psychopathology distress, and that this relationship may be explained by an impairment in interpersonal adjustment. Such preliminary findings may constitute a useful starting point for investigating this hypothesis among clinical populations.

Validity of a Brief Interview for Assessing Reflective Function

The Reflective Function Scale was developed by Fonagy and colleagues (1998) to empirically measure the capacity to mentalize thoughts, intentions, feelings, and beliefs about oneself and others. Reflective Function (RF) has been reliably measured by the Adult Attachment Interview (AAI; Main and Goldwyn 1998), but its length (45–90 minutes) and the labor required to administer, transcribe, and code for RF may be prohibitive for many research studies. The present study measured the reliability and validity of the Brief Reflective Function Interview (BRFI; Rudden, Milrod, and Target 2005) by administering it to 27 undergraduate participants previously assessed using the AAI in another research study (Morrison 2010). The BRFI was coded reliably by two independent raters (ICC = .79) and yielded a highly significant positive correlation (r = .71) between RF scores obtained by BRFI and by AAI. The average administration time of the BRFI (M = 24.15 minutes) was significantly shorter than that of the AAI (M = 44.65 minutes). These findings suggest that the BRFI may offer a reliable, valid, and streamlined alternative to the AAI as a measure for coding RF.

Assessing interpersonal profiles associated with varying levels of effortful control.

Research has linked individual differences in effortful control (EC) with variations in interpersonal functioning in children and adolescents. Using the Inventory of Interpersonal Problems–Short Circumplex (Hopwood, Pincus, DeMoor, & Koonce, 2008), this study investigated interpersonal problem profiles associated with EC in 763 nonclinical young adults. We found that individuals with low EC reported intrusive interpersonal problems and high levels of interpersonal distress, whereas individuals with high EC reported cold interpersonal problems but low levels of interpersonal distress. Results suggest that EC might play an important role in shaping interpersonal functioning.

Self-regulation and internal resources in school-aged children with ADHD symptomatology: an investigation using the Rorschach inkblot method.

This study assesses the capacity for emotional self-regulation and internal resources in a sample of urban children with ADHD symptomatology using the Rorschach Inkblot Method (RIM). Because these children have profound difficulty with modulating their affect, it is hypothesized that this difficulty would be reflected on RIM variables that have traditionally been thought to reflect the internal resources necessary for these children to regulate emotions. Children with greater ADHD symptoms were found to display lower scores on variables indicating internal resources for emotional self-regulation and stress tolerance (M, EA) relative to a comparison group with fewer ADHD symptoms. The research and clinical implications of these findings are discussed.

Change in Attachment and Reflective Function in Borderline Patients with and without Comorbid Narcissistic Personality Disorder in Transference Focused Psychotherapy

Abstract Research has consistently found high rates of comorbidity between narcissistic personality disorder (NPD) and borderline personality disorder (BPD). Patients with this complex clinical presentation often present formidable challenges for clinicians, such as intense devaluation, entitlement, and exploitation. However, there is a significant gap in the literature in identifying the clinical characteristics of these NPD/BPD patients. In this article, we present recent research describing patients with comorbid NPD/BPD, as compared with patients with BPD without NPD (BPD), from two randomized clinical trials for the treatment of borderline personality disorder, with a particular emphasis on attachment status and mentalization. We anchor our discussion of these patients in object relations and attachment theory, and we describe our treatment approach, transference focused psychotherapy (TFP). We conclude by using case material to illustrate our research findings, highlighting the significant differences between patients with NPD/BPD and BPD/non-NPD in terms of their attachment classification.

Attachment and Object Relations in Patients With Narcissistic Personality Disorder: Implications for Therapeutic Process and Outcome

This article presents a therapeutic approach for patients with severe personality disorders, transference-focused psychotherapy (TFP), a manualized evidence-based treatment, which integrates contemporary object relations theory with attachment theory and research. Case material is presented from a narcissistic personality disorder (NPD) patient in TFP whose primary presenting problems were in the arena of sexuality and love relations, and whose attachment state of mind showed evidence of oscillation between dismissing and preoccupied mechanisms. Clinical process material is presented to illustrate the tactics and techniques of TFP and how they have been refined for treatment of individuals with NPD. The ways in which conflicts around sexuality and love relations were lived out in the transference is delineated with a focus on the interpretation of devalued and idealized representations of self and others, both of which are key components of the compensatory grandiose self that defensively protects the individual from an underlying sense of vulnerability and imperfection.

An Update and Overview of the Empirical Evidence for Transference-Focused Psychotherapy and Other Psychotherapies for Borderline Personality Disorder

It is generally believed that psychoanalytically or dynamically oriented clinicians are not interested in research for a host of reasons ranging from the challenges of designing a randomized controlled trial that would demonstrate the efficacy of a psychoanalytic approach to epistemological and philosophical disagreements about the nature of science (see [1–3] debates for an illustration). Although many in the psychoanalytic community have in the past been cautious regarding the value of research, some of the earliest psychotherapy research was performed by psychoanalysts [4–12]. Additionally, psychoanalyst and psychodynamic clinicians are increasingly becoming interested in testing psychodynamic hypotheses and establishing a stronger evidence base for treatments based on psychodynamic ideas [2, 3, 13–20]. This increased interest in psychotherapy outcome research has been particularly fruitful with regard to the study of borderline personality disorder. Severe personality disorders such as borderline personality disorder are increasingly seen as the mainstay of psychoanalytic clinical work.

Mental state identification, borderline pathology, and the neglected role of childhood trauma.

Research evaluating mental state identification in individuals with borderline pathology has yielded inconsistent results; contradictory findings were hypothesized to be driven by moderating effects of childhood trauma. Participants were 105 ethnically diverse men and women who exhibited a range of borderline pathology measured by Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for borderline personality disorder. Mental state identification accuracy was measured using the Reading the Mind in the Eyes Test (RMET). Greater childhood abuse, but not childhood neglect, was associated with enhanced mental state identification accuracy on negative stimuli, when controlling for dissociation (ps < .05); these findings could not be explained by reaction time (RT) or response bias. Childhood abuse and childhood neglect were not related to mental state identification accuracy on neutral or positive stimuli, and they did not moderate the relationship between borderline pathology and mental state identification accuracy on negative, neutral, or positive stimuli. Borderline pathology was not independently related to mental state identification accuracy on negative, neutral, or positive stimuli. Greater childhood neglect, but not childhood abuse, was related to slower RTs on negative, neutral, and positive stimuli (ps < .05). Results underline the importance of separately assessing childhood abuse and childhood neglect and of controlling for dissociation, and they suggest borderline pathology may not universally hinder complex mental state identification.

Assessing Interpersonal Subtypes in Depression

The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are related to symptom chronicity. This study evaluated interpersonal pathoplasticity in a range of depressive presentations. We examined archival data collected from 407 participants who met criteria for major depressive disorder (MDD), dysthymic disorder (DD), or subthreshold depression (sD). Latent profile analysis (LPA) identified 5 interpersonal subtypes (vindictive, intrusive, socially avoidant, exploitable, and cold). Apart from gender, the subtypes did not differ significantly on demographic characteristics, psychiatric comorbidity, or self-report depression severity. Socially avoidant participants were more likely to meet criteria for a clinical depression diagnosis (MDD or DD), whereas vindictive participants were more likely to have sD. Our results indicate that interpersonal problems could account for heterogeneity observed in depression.