Louis Diguer

Psychological health-sickness (PHS) as a predictor of outcomes in dynamic and other psychotherapies.

This is the first dedicated review of quantitative studies on Sigmund Freuds proposition that the poorer the psychological health, the more limited are the benefits from treatment. Since observer-rated scales for psychological health-sickness were developed in 1949, many studies have applied them, and the majority show significant prediction of outcomes of psychotherapy, with correlations between .2 and .35. This article reviews (a) the main methods of measurement, (b) the record of predictive success, (c) validity studies, (d) the relation to psychiatric diagnosis, (e) prediction in forms of treatment other than psychotherapy, and (e) theories of why psychological health predicts outcomes of psychotherapy.

The Same Old Song?—Stability and Change in Relationship Schemas From Adolescence to Young Adulthood

Relationship schemas are core elements of personality that guide interpersonal functioning. The aim of this study is to examine stability and change in relationship schemas across two developmental epochs—adolescence and young adulthood—in the stories that people tell about their interactions with others. Using the Core Conflictual Relationship Theme Method, relationship themes were coded from semistructured interviews conducted in adolescence and again at age 25. The sample consisted of 40 participants in a longitudinal study of adolescent and young adult psychological development. There was considerable stability in the frequency with which particular themes were expressed in the narratives of adolescents and young adults. Significant changes from adolescence to young adulthood included a decrease in the perception of others as rejecting and of the self as opposing others. Young adults saw themselves and others more positively, and used a broader repertoire of themes in their relationship narratives than they had as adolescents. The basic continuity and particular changes in relationship schemas found in this study are consistent with knowledge about the adolescent-to-young-adult transition derived from other empirical and clinical findings. Relationship schemas may be rich units of study for learning about the development of interpersonal functioning.

The Penn psychoanalytic treatment collection: A set of complete and recorded psychoanalyses as a research resource

From a set of seventeen complete and tape-recorded psychoanalyses, a sample of findings is presented: (a) the level of agreement of two clinical judges on the psychological health of these patients is adequate for the late sessions, but not for the early sessions; (b) the amount of change during psychoanalysis appears to be similar to that in the Menninger Foundation Psychotherapy Research Project; (c) psychiatric severity measures from the early sessions can yield a significant level of prediction of the later benefits from psychoanalysis. Finally, further research uses of this collection of psychoanalyses are suggested.

The Impact of Level of Personality Organization on Treatment Response: A Systematic Review

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.

The Personality Organization Diagnostic Form: Development of a Revised Version

The purpose of this study is to examine the interrater reliability, validity, and internal consistency of a revised version of the Personality Organization Diagnostic Form (PODF; Diguer et al., 2001), a measure that evaluates the major dimensions of Kernbergs model of Personality Organizations (PO). Results show that the revised PODF can be scored with an interrater reliability ranging from good to excellent for the personality dimensions and the global PO (GPO) score. Factor analysis shows that items tend to regroup according to Kernbergs model. The optimal solution includes 2 factors: a borderline-neurotic continuum and a psychotic factor. Internal consistency and convergence with clinical evaluations also indicate moderate to good validity. Convergent validity with mental health and psychiatric severity is good, and in accordance with Kernbergs model. The revised PODF therefore appears to possess sound psychometric properties, with numerous advantages over its predecessor. Its utility for clinical and research work is also discussed.

Are Some Psychotherapies Much More Effective Than Others

In a previous paper we had reported on the examination of comparisons of 18 metaanalyses of active treatments with each other (Luborsky, Rosenthal, Diguer, et al., 2001). These metaanalyses gave a small and nonsignificant mean level of difference between types of treatments. The smallness of this correlation confirms Rosenzweigs (1936) expectation that because of the large overlap in effective ingredients of different psychotherapies, comparative studies of psychotherapies would show little difference. Such a comparison that includes psychoanalyses seems a long way off, but if outcomes of psychoanalyses are defined similarly to those in the other psychotherapies, the expected differences in outcomes may also be small.

Repetitive relationship themes in waking narratives and dreams

The aims of the study were to see whether the core conflictual relationship theme (CCRT) measure can be reliably applied to dreams and to evaluate the degree to which the main components of the CCRT are present in both dreams and waking narratives in psychotherapy. For 13 psychoanalytic cases, the reliability of the CCRT was found to be good. Dreams and narratives were found to contain significant degrees of similarity in their CCRT components and similar and high level of negativity in both dreams and waking narratives. The results support the concept of a central relationship pattern that can be expressed in common in both waking narratives and dreams.

Personality Organizations, Psychiatric Severity, and Self and Object Representations.

This study examined the hypothesis that psychotic, borderline, and neurotic personality organizations (POs) present a progressive differentiation between self and object representations and an increasing integration of their bad and good aspects. Fifty patients participated in the study. Measures included scales of self and object representations (S. J. Blatt, S. A. Bers, & C. E. Schaffer, 1993; S. J. Blatt, H. Wiseman, E. Prince-Gibson, & C. Gatt, 1991), as well as the Personality Organization Diagnostic Form (L. Diguer & L. Normandin, 1997) and estimations of psychiatric severity. Results showed that PO groups differed in terms of the integration of the object and its valence. It was also observed that although object and self representations were closely intertwined, the latter showed more discrimination between POs than the former. Psychiatric severity was shown to correlate more with object representations than self representations.

Personality organization, five-factor model, and mental health.

Otto Kernberg has developed a model of personality and psychological functioning centered on the concept of personality organization. The purpose of this study is to empirically examine the relationships between this model, the five-factor model, and mental health. The Personality Organization Diagnostic Form (Diguer et al., The Personality Organization Diagnostic Form-II (PODF-II), 2001), the NEO Five-Factor Inventory (Costa and McCrae, Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) Professional Manual. 1992a), and the Health-Sickness Rating Scale (Luborsky, Arch Gen Psychiatry. 1962;7:407–417) were used to assess these constructs. Results show that personality organization and personality factors are distinct but interrelated constructs and that both contribute in similar proportion to mental health. Results also suggest that the integration of personality organization and factors can provide clinicians and researchers with an enriched understanding of psychological functioning.

The impact of mentalization training on the reflective function of novice therapists: A randomized controlled trial

Abstract This study examined whether training can increase the reflective function (RF) of novice therapists about patients with Borderline Personality Disorder (BPD). A total of 48 students in clinical psychology were randomly assigned to mentalization training or didactic training. Their RF regarding patients was assessed with the Therapist Mental Activity Scale (TMAS: Normandin, Ensink, & Maheux, 2012). The RF of trainees assigned to the mentalization training improved significantly, while participants who received traditional didactic training actually became significantly less reflective. These findings show that brief mentalization training can help beginner therapists develop their mentalization capacities with challenging patients.