Personality pathology severity, cluster type and specific therapeutic interventions in outpatient psychotherapy

Abstract

We explored the relationship between severity of personality pathology, cluster type and therapeutic interventions (psychodynamic–interpersonal [PI] and cognitive–behavioural [CB]) in 76 outpatients across two early sessions (3rd and 9th) of psychodynamic psychotherapy, while accounting for patients' baseline global symptom severity. Pretreatment personality pathology severity was assessed using the Personality Disorder Index (PDI), where DSM‐IV Axis II PD was assigned a value of 2, subclinical traits and features were assigned a 1 and absence of Axis II psychopathology was assigned a 0. Interrater reliability of personality pathology severity was excellent (ICC [1, 1]: 0.85). Interrater agreement for Cluster A (κ = 0.75), Cluster B (κ = 0.92) and Cluster C (κ = 0.70) was high. Interventions were coded with Comparative Psychotherapy Process Scale (CPPS) from videotapes, and reliability was excellent (CPPS‐PI = 0.86; CPPS‐CB = 0.78). Stepwise linear regressions indicated that therapists' focus on mood shift/topic avoidance (B = 0.29, p = .009) and future events (B = −0.26, p = .020) predicted Axis II severity. Overall use of PI techniques and Cluster A personality disorder (CLA) were positively correlated (r = .312, p = .006). Stepwise binomial logistic regressions indicated that therapists' focus on uncomfortable feelings (B = 1.915, p = .008) and explaining rationale behind approach (B = 1.276, p =. 038) predicted CLA. All results remained significant when controlling for patients' baseline general symptomatology (Brief Symptom Inventory‐Global Severity Index [BSI‐GSI]), except for the relation between explaining rationale and CLA. Discussion highlights how using psychodynamic treatment model, therapists' focus on patient's in‐session affect expression and explaining rationale behind approach are highly relevant when working with CLA patients.

Personality Assessment Inventory Clinical Scales in Relation to Patient and Therapist Rated Alliance Early in Treatment

“…This was not a SCID interview, but many DSM-IV criteria for specific disorders were evaluated. The ability, and reliability, of this interview to diagnose both Axis I and II disorders has been demonstrated in previous literature (Cersosimo & Hilsenroth, 2020;Hilsenroth et al, 2004;Katz et al, 2019;Slavin-Mulford et al, 2011).…”

Patient personality characteristics and therapeutic integration: treating borderline personality and emotionally dysregulated-dysphoric personality features

“…Table 1 displays the demographic information as well as the distribution of patients' primary Axis I and II diagnoses for the entire sample in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994). Independent clinical ratings of DSM diagnoses for depression, anxiety and Axis II disorders for this sample have demonstrated excellent interrater reliability (Cersosimo & Hilsenroth, 2021;Hilsenroth et al, 2004;Hilsenroth, 2007, Katz et al, 2019Slavin-Mulford, Hilsenroth, Weinberger, & Gold, 2011;Stein, Pinsker-Aspen, & Hilsenroth, 2007). This sample consisted of primarily mood-disordered patients with relational problems manifested in either Axis II personality disorders or subclinical traits/features of Axis II personality disorders (Cluster A, N = 8; Cluster B, N = 38; Cluster C, N= 28).…”

Profiles of adherence and flexibility in psychodynamic psychotherapy: A cluster analysis.

“…Table 1 displays the demographic information and the distribution of patients’ primary axes I and II diagnoses in accordance with the DSM–IV . Independent clinical ratings of DSM diagnoses for depression, anxiety (ICC = .88; see Slavin-Mulford, Hilsenroth, Weinberger, & Gold, 2011), and Axis II psychopathology (ICC = .85; see Cersosimo & Hilsenroth, 2020) disorders for this sample have demonstrated excellent interrater reliability (e.g., Hilsenroth, 2007).…”

“…NOS = not otherwise specified; BSI-GSI = Brief Symptom Inventory-Global Severity Index; GAF = Global Assessment of Functioning. Hilsenroth, Weinberger, & Gold, 2011), and Axis II psychopathology (ICC = .85; see Cersosimo & Hilsenroth, 2020) disorders for this sample have demonstrated excellent interrater reliability (e.g., Hilsenroth, 2007).…”