Lolafaye Coyne

Dissociative detachment relates to psychotic symptoms and personality decompensation.

Previous studies have addressed the prominence of psychotic symptoms in conjunction with multiple personality disorder (now dissociative identity disorder). The present study examines the relation between psychotic symptoms and a more pervasive form of dissociative disturbance, namely dissociative detachment. Two hundred sixty-six women in inpatient treatment for severe trauma-related disorders completed the Dissociative Experiences Scale (DES), and 102 of these patients also completed the Millon Clinical Multiaxial Inventory (MCMI-III). A factor analysis of the DES yielded two dimensions of dissociative detachment: detachment from ones own actions and detachment from the self and the environment. Each of these DES dimensions relates strongly to the thought disorder and schizotypal personality disorder scales of the MCMI-III. We propose that severe dissociative detachment, by virtue of loosening the moorings in inner and outer reality, is conducive to psychotic symptoms and personality decompensation.

Dissociation and vulnerability to psychotic experience. The Dissociative Experiences Scale and the MMPI-2.

Prior research on the MMPI has cautioned against misdiagnosing schizophrenia in patients with dissociative identity disorder. The present study examined the full spectrum of the dissociative experience in relation to MMPI-2 profiles. Ninety-eight women in treatment for trauma-related disorders completed the Dissociative Experiences Scale and the MMPI-2 in routine inpatient diagnostic evaluations. Consistent with prior research, severe dissociation was associated with high elevations on MMPI-2 scales typically associated with psychotic symptoms. Contrary to hypotheses, the ostensibly most benign form of dissociation, absorption and imaginative involvement, was somewhat more strongly related to MMPI-2 scores than the more pathognomonic forms of dissociation, depersonalization and amnesia. Although it should not be misdiagnosed, severe impairment on the MMPI in conjunction with dissociation should be taken seriously as suggesting vulnerability to psychotic experience. The dissociative retreat from the stressors of outer reality opens the door to the inner world of traumatic images and affects, along with compromised reality testing and disorganized thinking.

Transference interpretation in the psychotherapy of borderline patients : a high-risk, high-gain phenomenon

&NA; The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference interpretations tended to have greater impact‐both positive and negative‐than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclltic rather than Introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapists difficulty in shifting to a more supportive approach when indicated.

Therapeutic alliance and long-term hospital treatment outcome

the quality of the therapeutic alliance is prominent in the thinking of all members of the [multidisciplinary treatment] team, it would seem important that this variable find a more consistent place in clinical research” (p. 420). Yet, there has been no systematic assessment of the role of the alliance in hospital treatment comparable to the work in the field of psychotherapy. The importance of the alliance was reaffirmed in a pilot study in which staff members described factors contributing positively and negatively to the treatment outcome for all patients discharged over the course of one year. Numerous characteristics reflecting the level of alliance emerged. On the positive side were reflectiveness, insightfulness, willingness to examine behavior, awareness of illness, willingness to work with staff, agreeing on treatment plans, wishing to work in treatment, determination to overcome problems, ability to set goals, and so forth; on the negative side were denial of illness, resisting exploration, oppositionalism. refusing to follow the treatment structure, acting out in such a way as to disrupt treatment, lack of desire to change, and inability to set realistic goals or to follow through with goals. Issues related to patient “likability” were mentioned even more frequently: indeed, some staff members speculated that patients’ likability might be the most significant predictor of the success of the treatment process inasmuch as the more likable patients might be expected to form more positive treatment relationships. On the positive side, this dimension included friendliness, charm, appeal, attractiveness, and sense of humor, along with references to patients’ capacities to form attachments and to evoke the interest and concern of staff; on the negative side were hostility, contempt, repugnant behavior, aloofness, and so forth. Like the alliance, likability has been found to play a positive role in the outcome of psychotherapy.‘-” Any attempt to research the alliance in relation to treatment outcome must come to terms with the wide variation in authors’ conceptualizations and assessment methods. Most researchers incorporate a broad range of positive and negative experiences and contributions to the alliance on the part of the patient and the

Menstrual migraine headache: results of a controlled, experimental, outcome study of non-drug treatments.

SYNOPSIS

Results of a controlled, experimental, outcome study of nondrug treatments for the control of migraine headaches

Headache variables were examined for 136 subjects who participated for 36 weeks in one of four groups-No Treatment, Autogenic Phrases, Electromyographic (EMG) Biofeedback, and Thermal Biofeedback. All subjects kept daily records of headache activity and medication usage and participated in 22 laboratory sessions during which frontalis electromyographic and handtemperature measurements were taken; those in the three treatment groups practiced at home. There was a substantial reduction in headache variables in all groups. The No-Treatment Group differed significantly from the treatment groups combined, with the least reduction in headache variables. The Thermal Biofeedback Group vs. EMG Biofeedback and Autogenic Phrases Groups showed a suggestive trend toward improvement in the frequency and intensity of total headache.

MMPI Profiles of Headache Patients Using Self‐regulation to Control Headache Activity

SYNOPSIS

TRAUMA PERVASIVELY ELEVATES BRIEF SYMPTOM INVENTORY PROFILES IN INPATIENT WOMEN

The Brief Symptom Inventory was administered to 228 women (M age: 37) consecutively admitted to specialized inpatient treatment for trauma-related disorders. Subsamples of patients were administered different posttraumatic stress disorder scales, the Impact of Events Scale–Revised, the Posttraumatic Stress Diagnostic Scale, and the PTSD scale of the Millon Clinical Multiaxial Inventory–Ill, as well as a measure of child abuse and neglect, the Childhood Trauma Questionnaire. In this severely traumatized group, every scale of the Brief Symptom Inventory was significantly more elevated than the inpatient female norms, with the five most highly elevated scales being Depression, Obsessive-Compulsive, Anxiety, Interpersonal Sensitivity, and Psychoticism. Different indicators of trauma (Childhood Trauma Questionnaire, PTSD scales, and PTSD diagnosis) show different patterns of relationships with the individual scales of the Brief Symptom Inventory. There is no simple relationship between trauma and BSI symptoms, but clinicians should consider severe interpersonal trauma to be one pathway to pervasively elevated profiles of the Brief Symptom Inventory.

RELATIVE POTENCY SCALE FOR ANALGESIC DRUGS: USE OF PSYCHOPHYSICAL PROCEDURES WITH CLINICAL JUDGMENTS

SYNOPSIS

The effect of therapist interventions on the therapeutic alliance with borderline patients.

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.