Rachel H. Wasserman

Conflict begets conflict: Executive control, mental state vacillations, and the therapeutic alliance in treatment of borderline personality disorder

Abstract Clinicians routinely note the challenges involved in psychotherapy with individuals with BPD, yet little research exists on the therapeutic alliance with this population. An important question is, what patient factors contribute to a disturbed alliance with individuals with BPD? Executive attention has been identified as a mechanism of BPD, and mental state vacillations (e.g., idealization/denigration, incoherence in self-concept) are a hallmark of the disorder. The goals of this study were to examine the link between executive attention and the alliance and assess mental state vacillations as a mediator. Thirty-nine participants diagnosed with BPD, participating in a randomized clinical trial, were administered the Attentional Network Task (ANT). Early psychotherapy sessions were coded using the Working Alliance Inventory (WAI). In addition, six items were generated and coded representing in-session vacillations in mental states. Performance on the ANT was related to the alliance (r=.34, p=.035), as were in-session mental state vacillations (r=.59, p<.001). A model was supported in which in-session mental state vacillations mediated the relationship between executive attention and alliance. Executive attention was related to therapeutic alliance, and this relationship was found to be mediated by in-session mental state vacillations. These findings emphasize the importance of executive attention in the disorder and uncover a link between poor executive attention and mental state vacillations. Mental state vacillations as a mediator suggests a path in which poor executive attention leads to greater vacillations, which leads to poorer working alliance.

Narcissistic Pathology: Empirical Approaches

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Generalizability theory in psychotherapy research: The impact of multiple sources of variance on the dependability of psychotherapy process ratings

Abstract A central task of psychotherapy process measurement development is the assessment of reliability and validity. The convention of reporting intraclass correlations (ICCs) for coding procedures assumes that variance in scores can be adequately explained by differences between individuals and error resulting from differences in coders. Given the complex coding procedures that are common in psychotherapy process studies (multiple sessions may be rated by multiple coders on one or more multi-item scales), an ICC may fail to account for all of the relevant sources of variability in obtained scores. If process studies are to provide useful information about the mutative agents in psychotherapy, assessment procedures must be developed that dependably assess the constructs of interest. Generalizability theory provides a framework within which multiple sources of error can be simultaneously evaluated, thus improving the accuracy of reliability estimates and providing critical information for modification and improvement of coding procedures. To illustrate the applicability of generalizability theory to psychotherapy process research, the authors present the design and findings of a study investigating the generalizability of technique scales in the Psychotherapy Process Rating Scale for Borderline Personality Disorder. Implications for measurement development and procedural modifications are discussed.

Empirical Evidence for Transference-Focused Psychotherapy and Other Psychodynamic Psychotherapy for Borderline Personality Disorder

Writing about psychodynamic psychotherapy for borderline personality disorder (BPD) is difficult because it is not a unified approach. In fact, it is often said that psychoanalysis, although frequently used singularly, is in actuality a plural noun representing an array of theoretical ideas and technical applications. These schools broadly include ego psychology, object relations theory, self-psychology, and attachment theory.

The development of a measure to assess putative mechanisms of change in the treatment of borderline personality disorder.

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Il trattamento del disturbo borderline di personalità : la psicoterapia focalizzata sul transfert : traduzione a cura di Giulio D'Adamo

The treatment of borderline personality disorder: transference focused therapy - The Authors address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists’ interventions that engender patient change. Mechanisms of change at the level of the patient involve the integration of polarized representations of self and others; mechanisms of change at the level of the therapist’s interventions include the structured treatment approach and the use of clarification, confrontation, and transference interpretations in the here and now of the therapeutic relationship. In addition, the Authors briefly review evidence from their group regarding the following hypothesized mechanisms of change: contract setting, integration of representations, and changes in reflective functioning (RF) and affect regulation. Key Words: Mechanisms of Change; Transference Focused Therapy; Borderline Personality Disorder.