Vittorio Lingiardi

The collaborative interactions scale: A new transcript-based method for the assessment of therapeutic alliance ruptures and resolutions in psychotherapy

Abstract The authors present a new transcript-based method for the assessment of therapeutic alliance ruptures and resolutions in psychotherapy—the Collaborative Interaction Scale (CIS)—and discuss the structure and theoretical background of the scale and the rating procedure. To assess interrater reliability, three raters independently evaluated 32 psychotherapy sessions (2,984 patient utterances and 2,984 therapist utterances) using the CIS, which demonstrated good interrater reliability (average κ=.66–.81). In evaluating the relationship between therapist interventions and patient alliance rupture and collaborative processes, the authors found significant correlations between therapist negative interventions and patient alliance ruptures and among therapist positive interventions, patient collaborative processes, and indirect rupture markers. Results indicate that the CIS is a reliable rating system, useful in both empirical research and clinical assessments.

Measure of Internalized Sexual Stigma for Lesbians and Gay Men: A New Scale

The goal of this study is to propose a new Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) that assesses three dimensions of internalized homonegativity: identity, social discomfort, and sexuality. A convenience sample of 735 Italian lesbians and gay male participants was used to demonstrate the psychometric validity of the scale. Results of confirmatory factor analysis supported three identifiable factors reflecting theoretically based constructs of the MISS-LG. The correlations with other instruments demonstrate the convergent validity: lesbian and gay participants with high internalized sexual stigma describe lower levels of self-disclosure and wellbeing. Implications for research and practice are discussed.

Assessing personality change in psychotherapy with the SWAP-200: A case study

Many studies document the efficacy of psychotherapy for acute syndromes such as depression, but less is known about personality change in patients treated for personality pathology. The Shedler–Westen Assessment Procedure (SWAP–200; Westen & Shedler, 1999a, 1999b) is an assessment tool that measures a broad spectrum of personality constructs and is designed to bridge the gap between the clinical and empirical traditions in personality assessment. In this article, we demonstrate the use of the SWAP–200 as a measure of change in a case study of a patient diagnosed with borderline personality disorder. We collected assessment data at the start of treatment and after 2 years of psychotherapy. The findings illustrate the personality processes targeted in intensive psychotherapy for borderline personality.

Playing with unreality: transference and computer.

In this paper I describe the impact of cyberspace on the analytical relationship. My reflections will move from two clinical histories. In the first history, I describe the case of Melania, a patient who, at a certain moment of her analysis, started sending me e‐mails, almost building a ‘parallel setting’. I describe the relational dynamics linked to the irruption of the electronic mail into the boundaries of our psychoanalytic relationship. The second case is Louis, a 25 year‐old young man with a schizoid personality who uses cyberspace as a psychic retreat. Over the years Louis told me, initially from a sidereal distance, of his necessity to create dissociative moments. The entrance to these retreats procures for Louis an immobile pacification, which may assume the characteristics of a trance: life comes to a halt in a state of ‘suspended animation’. We can see the use that Louis makes of the computer as an attempt to live into a non‐human object and to protect himself from relational anguish, but also to warm up a mechanical mother. Melania used technology to communicate with me, albeit in a roundabout way; for Louis, virtual space was a ‘dissociative retreat’ located on the border between sleeping and waking, which for years went untouched by our analytical discourse. For both patients, the computer was a tool for emotional regulation, and the analytical relationship aimed to give this tool some relational meaning, facilitating the shift from compulsive usage to a transformative use of the object.

Personality subtypes in adolescents with anorexia nervosa

The aims of this study are to (1) empirically identify the personality subtypes of adolescents with anorexic disorders and (2) investigate the personality disorders, identity disturbances, and affective features associated with the different subtypes. We assessed 102 adolescent patients with Eating Disorders (anorexia nervosa and eating disorder not otherwise specified) using three clinical instruments: the Shedler-Westen Assessment Procedure for Adolescents (SWAP-200-A) (Westen D, Shedler J, Durrett C, Glass S, Martens A. Personality diagnoses in adolescence: DSM-IV Axis II diagnoses and an empirically derived alternative. Am J Psychiatry 2003;160:952-966), the Affective Regulation and Experience Questionnaire (AREQ) (Zittel Conklin C, Bradley R, Westen D. Affect regulation in borderline personality disorder. J Nerv Ment Dis 2006;194:69-77), and the Identity Disorder Questionnaire (IDQ) (Wilkinson-Ryan T, Westen D. Identity disturbance in borderline personality disorder: An empirical investigation. Am J Psychiatry 2000;157:528-541). We performed a Q factor analysis of the SWAP-200-A descriptions of our sample to identify personality subtypes. We correlated these personality styles with AREQ and IDQ factors and explored the personality differences among individuals with the different types of ED. The Q factor analysis identified three personality subtypes: high-functioning/perfectionist, emotionally dysregulated, and overcontrolled/constricted. Each subtype showed specific identity and affective features, comorbidities with different personality disorders, and clinical implications. These results contribute to the understanding of adolescents with ED and seem to be relevant for treatment planning.

Suicidal ideation in Spanish and Italian lesbian and gay young adults: the role of internalized sexual stigma

BACKGROUND A growing body of research claims that sexual minority individuals have nearly twice the suicidal ideation rate of heterosexual individuals. METHOD The main objective of the current study was to test a model wherein internalized sexual stigma (ISS) mediates the association between some gay-related stressors and suicidal ideation. The present cross-sectional survey involved two samples of lesbian and gay young adults from Spain (N = 209) and Italy (N = 345). The total sample included 316 gay men and 228 lesbian women. Path analysis was used to test the direct and indirect (mediated) effects of the variables from different domains on repulsion by life. RESULTS In both the Spanish and Italian samples, past victimization experiences and ISS had a significant direct effect on repulsion by life. In both samples, ISS acted as a significant mediator in the effect of the concealment of ones sexual orientation and the religious involvement of repulsion by life. CONCLUSION The current study indicates that ISS is a potential moderator of the effect of concealing ones sexual orientation, religious involvement, and past experiences of victimization on suicidal attitudes.

AAI predicts patients’ in-session interpersonal behavior and discourse: a “move to the level of the relation” for attachment-informed psychotherapy research

There is currently little empirical evidence regarding how patients’ attachment patterns manifest in individual psychotherapy. This study compared the in-session discourse of patients classified secure, dismissing, and preoccupied on the Adult Attachment Interview (AAI). Rather than focusing on content or form alone, this study analyzed how patients’ discourse elicits and maintains emotional proximity with the therapist. The AAI was administered to 56 patients prior to treatment and one session for each patient was rated with the Patient Attachment Coding System (PACS) by four independent raters, blind to patients’ AAI classification. Significant differences were found in the discourse of patients with different attachment patterns. Namely, secure and preoccupied patients showed more contact-seeking behavior than dismissing patients, who avoided emotional proximity more, while preoccupied patients resisted therapists’ help more than did secure and dismissing patients. These results suggest that the different attachment patterns may have distinctive manifestations in the psychotherapy process that can be tracked by external observers.

The Psychodynamic Diagnostic Manual (PDM) and the PDM-2: Opportunities to Significantly Affect the Profession

In this article, we discuss the development of the Psychodynamic Diagnostic Manual (PDM) and its upcoming revision, the PDM-2. We describe the processes by which the PDM-2 is being developed and highlight important differences across both editions. At the same time, we emphasize the value of assessing internalized experience and how that can be of use toward the diagnostic assessment process.

Same-sex parent families in Italy: Validation of the Coparenting Scale-Revised for lesbian mothers and gay fathers

Abstract Even though Italy is still struggling to establish equal rights and access to assisted reproduction techniques for sexual minorities, an increasing number of lesbian women and gay men are now becoming parents. There are only a few studies that have evaluated coparenting in same-sex couples. However, these addressed adoptive couples and not the lesbian and gay parent families through donor insemination or surrogacy, respectively. This study examined the psychometric properties of the Coparenting Scale-Revised and its relationship with dyadic adjustment, discipline management, and internalized sexual stigma in Italian same-sex-planned families. The factor structure showed a satisfactory internal consistency and criterion validity with correlates of coparenting behaviours. While Family Integrity factor was confirmed, Disparagement and Reprimand dimensions collapsed into Conflict factor. Non-genetic parents showed lower levels of conflict than genetic parents. Most importantly, coparenting emerged as a significant function not shaped by gender, but influenced by parental status and internalized sexual stigma.

Negative Attitudes to Lesbians and Gay Men: Persecutors and Victims

Negative attitudes toward lesbians and gay men widespread in multiple spheres including mass media, politics, public institutions, pseudoscientific contexts, and interpersonal relationships can be very distressing and sometimes unbearable for the victims. The adoption of the term “homophobia” [Weinberg (Society and the healthy homosexual, 1972)], although it is not entirely satisfactory, can be considered a milestone in Social Sciences because it marked the transition of scientific paradigm from homosexuality (and its “causes”) to antigay hostility (and its causes). For clinical and research purposes, it is important to consider the role of prejudice in affecting psychological well-being and producing minority stress in gay people and their families. At the same time, a comprehensive understanding of sexual prejudice as a form of abuse is necessary to develop prevention policies and practices (e.g., against homophobic bullying) and to avoid antigay biases and secondary victimization (e.g., in the clinical settings). Some tools for the assessment of both explicit and implicit sexual prejudice (both in straight and gay people) will be briefly discussed.