Rudi Vermote

Process and outcome in psychodynamic hospitalization-based treatment for patients with a personality disorder.

This study examined the relationship between the psychotherapeutic process and outcome in 44 patients who completed hospitalization-based psychodynamic treatment for personality disorders. Using self-report and interview ratings, outcome was assessed in terms of symptoms and personality functioning, and the psychotherapeutic process in terms of self and object relations, felt safety, and reflective functioning. Symptom and process measures were administered at intake, every 3 months during treatment, and at 3 and 12 months follow-up. Personality measures were collected at intake, the end of treatment, and at 3 and 12 months follow-up. Using Piecewise Linear Growth Curve Analysis results showed improvement in symptoms, personality functioning, self and object relations and felt safety, but not in reflective functioning. Linear changes in self and object representation and felt safety, but not in reflective functioning, predicted improvement in outcome.

Outcome and Outcome Trajectories of Personality Disordered Patients During and After a Psychoanalytic Hospitalization-Based Treatment

This study aims to identify different outcome trajectories in a psychoanalytic hospitalization-based treatment in a sample of 70 patients with personality disorders using a naturalistic 12 month follow-up design. Trajectory analysis identified four groups of patients, i.e., patients showing (a) high initial symptom levels and considerable and consistent improvement late in treatment (High-Low group; HL), (b) medium initial symptom levels and a quick and sustained response (Medium-Low group; ML), (c) medium initial symptom levels but without substantial improvement (Medium-Medium group; MM), and (d) low initial symptom levels without substantial further improvement during and after treatment (Low-Low group; LL). Further, data suggested that these four trajectories were related in theoretically meaningful ways to pre-treatment variables, such as anaclitic and introjective personality styles and trauma. Results are discussed in the context of other studies showing the need for differential treatment approaches based on pretreatment characteristics.

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.

Suicide in young schizophrenic patients during and after inpatient treatment

The frequency of suicide in schizophrenia, as recorded in different studies, varies between 1% and 18%. Miles, from a review of 34 studies [3], estimated that 10% of all persons with schizophrenia would commit suicide. The lowest figures are found in studies of older schizophrenic patients; the period of initial hospitalization and diagnosis seems to be one of particular risk for suicide. Drake and co-workers [4], having reviewed 25 empirical studies, concluded that important risk factors for suicide included being young, male, and in the early years of illness and having a clinical course characterized by many exacerbations and remissions.

The Inventory of Personality Organization–Revised: Construction of an abridged version.

The Inventory of Personality Organization (IPO, Kernberg & Clarkin, 1995; Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001) is a self-report instrument intended to measure a patients level of personality organization. This manuscript describes the devel- opment of a shortened version of the IPO (the IPO-R). Construct validity of the IPO-R is determined by investigating (a) its latent structure, (b) the equivalence of this latent structure in a normal and a clinical sample (structural validity), and (c) differences between mean scores of the IPO-R scales for a normal population, axis-I disordered and axis-II disordered patients (concurrent validity). The IPO-R showed adequate construct validity in a normal and a clinical sample.

The Construct Validity of the Dutch Personality Inventory for DSM-5 Personality Disorders (PID-5) in a Clinical Sample:

The factor structure and the convergent validity of the Personality Inventory for DSM-5 (PID-5), a self-report questionnaire designed to measure personality pathology as advocated in the fifth edition, Section III of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), are already demonstrated in general population samples, but need replication in clinical samples. In 240 Flemish inpatients, we examined the factor structure of the PID-5 by means of exploratory structural equation modeling. Additionally, we investigated differences in PID-5 higher order domain scores according to gender, age and educational level, and explored convergent and discriminant validity by relating the PID-5 with the Dimensional Assessment of Personality Pathology—Basic Questionnaire and by comparing PID-5 scores of inpatients with and without a DSM-IV categorical personality disorder diagnosis. Our results confirmed the original five-factor structure of the PID-5. The reliability and the convergent and discriminant validity of the PID-5 proved to be adequate. Implications for future research are discussed.

On the value of 'late Bion' to analytic theory and practice.

Most colleagues will no doubt agree that Bion’s theory of thinking has become an integral part of the truncus communis of psychoanalytic theory. It is among the theories responsible for shifting the focus of psychoanalysis from the content of unconscious manifestations to their actual psychic processing. It opened new treatment perspectives, especially in the treatment of severe pathology. However, Bion’s later work, with its focus on ‘O’ and its recommendation of a clinical attitude of ‘no memory, no desire, no coherence, no understanding’ has evoked many mixed reactions, ranging from criticisms of the theory for its foolishness to idolatry. In what follows I will take the position that Bion’s later work provides an important contribution theory and practice and that is possible to use in combination two models that are outlined in the ‘early’ and the ‘late’ Bion to produce a dual track model of psychic change.

LEVELS OF PERSONALITY FUNCTIONING AND THEIR ASSOCIATION WITH CLINICAL FEATURES AND INTERPERSONAL FUNCTIONING IN PATIENTS WITH PERSONALITY DISORDERS

Recently, the DSM-5 Personality and Personality Disorders Work Group has proposed a multiple level approach toward the classification and diagnosis of personality disorders (PDs), with the first level entailing a rating of impairments in levels of personality functioning. Although a number of measures that assess levels of personality functioning have been validated, given its prominent status in the DSM-5 proposal and contemporary theories of personality pathology, the Work Group has called for more research in this area (e.g., Bender, Morey, & Skodol, 2011). In response to this call, this study investigates the relationship between two major, well-validated dimensional measures of levels of personality functioning, that is, the Differentiation-Relatedness Scale (DR-S; Diamond, Blatt, Stayner, & Kaslow, 1991), as scored on the Object Relations Inventory (ORI; Blatt, Wein, Chevron, & Quinlan, 1979), and the Inventory of Personality Organization (IPO; Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001), a self-report instrument, and their relationship with different measures of clinical and interpersonal functioning in 70 patients with a PD. First, results showed that higher levels of differentiation and relatedness of descriptions of self and significant others, and of the self in particular, were negatively related to indices of personality functioning as assessed by the IPO. Lower levels of personality functioning, as measured with both the DR-S and the IPO, were positively related to severity of depression, symptomatic distress, self-harm, and interpersonal problems. Finally, results showed that the DR-S and the IPO independently predicted clinical features and interpersonal functioning. Hence, this study lends further support for the concurrent and predictive validity of the DR-S and the IPO in assessing levels of personality functioning. However, more research concerning the validity of these measures in assessing levels of personality functioning is needed. Suggestions for further research are formulated.

Patterns of inner change and their relation with patient characteristics and outcome in a psychoanalytic hospitalization‐based treatment for personality disordered patients

This study investigated whether different clusters of patients with personality disorders in a psychoanalytic hospitalization-based treatment were associated with: (a) different changes in personality organization (PO); (b) different pre-treatment variables; and (c) different associations between changes in PO and outcome. K-means clustering analysis identified two clusters of patients, which showed different changes in PO and mainly differed in terms of levels of anaclitic and introjective personality features, respectively. Both clusters showed a significant decrease in symptoms and an improvement in personality functioning during treatment and at 3-month follow-up. Clinical implications of these findings are discussed.

The relationship between interpersonal problems and outcome in psychodynamic hospitalization-based treatment for personality disorders: A 12-month follow-up study

Disturbances in interpersonal relationships are a core feature of personality disorders. Psychodynamic formulations in particular consider interpersonal problems as a central characteristic of personality pathology. Yet, despite the centrality of interpersonal issues in both theoretical conceptualizations and psychodynamic treatment approaches, relatively few studies have investigated the role and nature of interpersonal problems in psychodynamic treatments for personality pathology. This study set out to investigate in a sample of 44 personality-disordered patients whether hospitalization-based psychodynamic treatment was associated with changes in interpersonal problems, as measured with the Inventory of Interpersonal Problems, at the end of treatment and at three- and 12-month follow-up. In addition, this study investigated whether specific types of interpersonal problems were associated with symptomatic outcome assessed during treatment, at the end of treatment, and at three- and 12-month follow-up, and whether changes in interpersonal problems from baseline to the end of treatment were related to outcome at follow-up. Results showed that psychodynamic treatment was associated with significant improvements in interpersonal problems during treatment, and continuing improvement in interpersonal functioning after treatment. Yet, problems in the cold-vindictive and domineering domain were negatively related to outcome during, but specifically after, treatment, and also tended to show little improvement during treatment. Finally, the extent to which these interpersonal features and interpersonal problems in the overly nurturant and non-assertiveness domains changed during treatment, was associated with symptomatic improvement, particularly at follow-up. The implications of these findings for the psychodynamic treatment of personality-disordered patients are discussed.