Differentiating Ego Functions of Borderline and Narcissistic Personalities

This study investigated differences in ego functions of borderline and narcissistic personality disorders through examining responses to Rorschach structural and content variables. Reality testing, thought process, affective regulation, impulse control, and the defenses of splitting and grandiosity were examined from Rorschach protocols of 50 borderlines and 26 narcissists. The borderlines produced greater distortion in reality testing, p < .05; the narcissists produced more insidious thought process disturbance, p < .05; and higher functioning groups demonstrated greater control of impulses, p < .05. Borderlines in this sample demonstrated more affective constriction than the narcissists and used more splitting, p < .05; narcissists used more grandiosity, p < .05. Implications of this study are (a) ego functions mature inconsistently, (b) affective responsivity influences ego disorganization, and (c) level of functioning and IQ are related to the production of Rorschach variables.     

The Role of Defense Mechanisms in Borderline and Antisocial Personalities

Fifty-eight adult male felons were given the Minnesota Multiphasic Personality Inventory (MMPI), the Buss-Durkee Hostility Inventory (BDHI), and the Draw-a-Person Test (DAP) to test the relative sensitivity of subtlety or obviousness of items to response Sets. The inmates were randomly assigned to three response set groups: a fake-aggressive group, a fake-nonaggressive group, and a standard-instruction control group. The MMPIs were scored for five obvious and five subtle aggression or hostility research scales. The BDHI is a totally obvious test, whereas the DAP is a very subtle measure. A paradoxical relationship between response set and subtlety of the scales was hypothesized, such that the obvious scales could be successfully faked, hut the subtle scales would show scores in the opposite from the intended direction. It was found that the inmates did correctly manipulate the obvious scales, but the subtle scales did not consistently show the hypothesized trend. Possible reasons for this are discussed, including the nature of the scales used and characteristics of the population.     

A Systems Approach to the Social Difficulties of Transsexuals in Hong Kong

This paper identifies social difficulties commonly faced by a group of forty-two Hong Kong transsexuals who had applied for sex reassignment surgery. It describes the use of a systems perspective to conceptualize their problems and a structural family therapy approach to social work intervention.     

A Sociological Approach to the Analysis of Preparation for Work Life

Preparation for work life is interpreted as involving 4 main kinds of preparation: (a) preparation for life in an organization, involving authority, security quests, impersonality, routine, conflict, mobility, and demotion, (b) preparation for a set of role relationships, (c) preparation for a level of consumption, involving a certain style of life, and (d) preparation for an occupational career, involving changes in the nature of jobs, and different types of jobs depending on the position in the life cycle. Conclusions suggest a broadening of the concept of “vocation,” and a change in approach to the analysis of the decision-making process from traditional stochastic analysis to “disjointed incrementalism,” that is, making decisions for short time-periods only, and with strict limitation on available data and resources.     

A Systems Approach to the Treatment of Chemical Addiction

Therapists are increasingly considering chemical addiction from a family systems perspective. Effects of chemical dependency upon the family are discussed and intervention approaches aimed toward assisting the family as families redefine themselves and change their structure are considered. The integration of chemical dependency treatment and the family therapy is also discussed as it is practiced in an intensive outpatient program at a psychiatric hospital.     

A Two-Systems Approach to the Treatment of a Disturbed Adolescent

Abstract

This article is based upon die rich conceptual and technical framework for understanding and treating sadomasochistic psycho-pathology presented by the Novicks (this volume). Specifically, the Novicks' “two-systems” approach to self-regulation is applied to the treatment of a disturbed adolescent boy. Examples of “open” and “closed” functioning are presented as well as the role of underlying defensive omnipotent beliefs and fantasies. The clinical utility of this model, the pivotal role of the therapeutic alliance, and the significance of clinical work with the family through all stages of the treatment process are illustrated.     

Group Pacing: A Developmental Eclectic Approach to Group Work

The authors examine a new approach to conducting group work, which is referred to as “developmental eclecticism.” Using Loevinger's (1976) theory of ego development as a guiding force in their counseling practice, the authors present a discussion that reflects various strategies implemented in working with a group of adults in a community mental health center setting.     

A Finer Grained Approach to Psychological Capital and Work Performance

Purpose

Psychological capital is a set of personal resources comprised by hope, efficacy, optimism, and resilience, which previous research has supported as being valuable for general work performance. However, in today’s organizations, a multidimensional approach is required to understanding work performance, thus, we aimed to determine whether psychological capital improves proficiency, adaptivity, and proactivity, and also whether hope, efficiency, resilience, and optimism have a differential contribution to the same outcomes. Analyzing the temporal meaning of each psychological capital dimension, this paper theorizes the relative weights of psychological capital dimensions on proficiency, adaptivity, and proactivity, proposing also that higher relative weight dimensions are helpful to cope with job demands and perform well.

Methodology

Two survey studies, the first based on cross-sectional data and the second on two waves of data, were conducted with employees from diverse organizations, who provided measures of their psychological capital, work performance, and job demands. Data was modeled with regression analysis together with relative weights analysis.

Findings

Relative weights for dimensions of psychological capital were supported as having remarkable unique contributions for proficient, adaptive, and proactive behavior, particularly when job demands were high.

Originality/Value

We concluded that organizations facing high job demands should implement actions to enhance psychological capital dimensions; however, those actions should focus on the specific criterion of performance of interest.

     

Remediating Reading Comprehension Difficulties: A Cognitive Processing Approach

The efficacy of a cognitive-based remediation program was investigated with 14 English-as-a-second-language (ESL) poor readers in Grade 4 who had significant difficulty in comprehension and 14 normal ESL readers in Grade 4 who received no remediation. Both groups were selected from 2 English-medium schools in India. We examined pretest-to-posttest changes in word reading, comprehension, and planning–attention–simultaneous–successive cognitive processes. Analyses of variance (ANOVAs) showed marked improvement in comprehension and some improvement in simultaneous processing for the treated group. The results indicate that the cognitive-based remediation program has potential for substantially improving comprehension and its underlying cognitive process among ESL children.     

Strategies Used in the Treatment of Borderline Personality Disorder: A Survey of Practicing Psychologists

One hundred and twenty three practicing psychologists completed surveys regarding the therapeutic techniques they employ for patients with Borderline Personality Disorder (BPD). Participants identified their predominant orientation and rated the frequency with which they used a range of 27 specific strategies. Logistic regression analyses identified an expected relationship between specific techniques and the theoretical orientations to which they are most closely linked. These findings suggest a high level of concordance between self-described theoretical orientation and the specific treatment techniques utilized, but also that some theoretical orientations are comprised of smaller independent clusters of strategies. The implications of these findings are discussed.     

Critical Issues in the Evaluation and Treatment of the Borderline Patient

No abstract available for this article.     

Chapter 3 Integrative Short-Term Treatment of the Borderline Patient

Abstract

The realities of current practice necessitate that clinicians engage in briefer forms of treatment with borderline patients despite the fact that long-term treatment has been considered the treatment of choice because of their entrenched and pervasive personality difficulties, severe developmental arrests, and history of trauma. Most short-term treatment models are ill-suited for work with the borderline population because they favor highly motivated and well-functioning patients who have circumscribed problems. Nevertheless, there is a considerable body of practice principles that can be adapted to brief treatment with borderlines. This paper reviews the clinical features of borderline disorders and current views on their origins and treatment and then describes the components of an integrative short-term treatment framework.     

A Negotiation Approach to Intake and Treatment Choice

Treatment choice is the decision process whereby the psychotherapeutic methods and the psychotherapist are determined when psychotherapy is recommended for a specific client. In this article the problem of treatment choice is situated within an integrative view of psychotherapy. A review of the literature confirms the usefulness of the following concepts for treatment choice: client preferences, client control of the situation of choice, and the mutual acceptability of differing views of therapists and clients. These research findings reveal the importance of four elements in the psychotherapeutic intake strategy: exploration of the client's perspective, informing the client, negotiation as a process of confrontation between the client's and the clinician's perspective, and the client's ultimate choice between alternative treatment proposals.     

Changing Ideas About the Treatment of Borderline Personality Disorder

Systematic treatment outcome studies and research on the structure and origins of the disorder are challenging many traditional ideas about the nature and treatment of borderline personality disorder. On the basis of this research, it is argued that a comprehensive treatment requires an eclectic approach that uses an array of interventions drawn from different therapeutic models that are delivered in an integrated and coordinated way. Such an approach conceptualizes treatment in terms of generic strategies designed to build an effective alliance and treat core self and interpersonal pathology and specific interventions to treat the various components of the disorder. It is also argued that there may be limits to the extent to which some aspects of borderline pathology can be changed. Borderline personality disorder is often a chronic condition that is best managed using a rehabilitation model.     

A Behavioural Medicine Approach to the Analysis and Treatment of Childhood Asthma

Abstract

Despite significant medical breakthroughs over the past decade in the discovery of the causes and treatment of asthma, clinical control of the illness has not improved. On the contrary, evidence suggests an increase in the prevalence and severity of childhood asthma. There is a consensus that learning factors influencing the development of symptoms must be understood and integrated into a total asthma management programme in order to ocor1ain optimal treatment results. The behavioural medicine approach focuses on helping the child and family recognize the constellation of risk factors which trigger attacks, develop constructive coping strategies for dealing with the attacks and develop healthy social skills regarding the asthma. The present paper presents an overview of the theoretical underpinnings of the behavioural medicine approach to childhood asthma, and a case study showing its practical applications.     

A Sullivanian Approach to the Problem of Reading Disability: Theoretical Considerations and Empirical Data

Since reading disabilities resemble operationally hysterical disorders, the applicability of some of Sullivan's (1947, 1956) conceptions about hysteria in the understanding of this symptom was explored. To this end a measure was designed to assess the degree to which children are sensitive and selectively attentive to hypocritical, insincere, and plain “silly” aspects of the world around them and/or their readiness to understand the sincere precepts of their culture. The instrument was essentially a modification and extension of the Verbal Absurdities items and the Proverb items of the Stanford-Binet Test (Terman & Merrill, 1960). If Sullivan's notions were applicable, then youngsters with reading disabilities should do better than their adequately reading control subjects on the Absurdity items; the reverse relationship was expected on the Proverbs items. Twenty children with marked reading retardation and a matched control group of equal size and reading at grade level expectancy served as research populations. All measures calculated rendered results supporting the hypotheses advanced at better than the .05 level of confidence. The implications of these findings for the theoretical understanding of the reading disability symptom from a Sullivanian vantage point are discussed.     

A Relational Approach to Career Counseling: Theoretical Integration and Practical Application

This article reviews the current status of career theory in practice and presents a theoretical overview of relational theory and its logical extension to the career domain. Despite the emergence of literature regarding the interconnectedness of career progress and the quality of relationships in one's life (e.g., D. L. Blustein, 2001; D. L. Blustein, M. S. Prezioso, & D. E. P. Schultheiss, 1995; D. E. P. Schultheiss, H. M. Kress, A. J. Manzi, & J. M. Glasscock, 2001), counseling practice is limited by the absence of a meaningful approach to intervene in clients' relational and career worlds. The relational career counseling approach moves counseling toward a contextually based relational perspective to facilitating career progress. This approach is illustrated with a case example.     

Effectiveness of Psychodynamic Treatment in Patients with Borderline Personality Disorder

There is some evidence that the efficacy of four types of psychotherapeutic psychotherapy (mentalized-based treatment, transference-focused psychotherapy, psychoanalytic psychotherapy, and cognitive-analytic therapy), is superior to treatment-as-usual. More controlled and randomized studies are needed in order a) to confirm the results of the relatively few investigations that were available, b) to examine the therapeutic relevance and usefulness of correlates and predictors of improvement and remission in borderline patients, and c) to examine possible fruitful combinations with other types of treatment.