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.     

Outpatient group psychotherapy following day treatment for patients with personality disorders

This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.     

Assessment of therapists' and patients' personality: relationship to therapeutic technique and outcome in brief dynamic psychotherapy

My first focus of this study was to explore therapists' personal characteristics as predictors of the proportion of interpretation in brief dynamic psychotherapy (N=39; maximum 40 sessions). In this study, I used data from the Norwegian Multicenter Study on Process and Outcome of Psychotherapy (1995). The main finding was that therapists who had experienced good parental care gave less interpretation (28% variance was accounted for). Therapists who had more negative introjects used a higher proportion of interpretation (16% variance was accounted for). Patients' pretreatment characteristics were not predictive of therapists' use of interpretation. The second focus was to investigate the impact of therapists' personality and the proportion of interpretation on the development of patients' maladaptive defensive functioning over the course of therapy. Better parental care and less negative introjects in therapists were associated with a positive influence and accounted for 5% variance in the reduction of patients' maladaptive defense.     

A room with a cue: personality judgments based on offices and bedrooms

The authors articulate a model specifying links between (a) individuals and the physical environments they occupy and (b) the environments and observers' impressions of the occupants. Two studies examined the basic phenomena underlying this model: Interobserver consensus, observer accuracy, cue utilization, and cue validity. Observer ratings based purely on offices or bedrooms were compared with self- and peer ratings of occupants and with physical features of the environments. Findings, which varied slightly across contexts and traits, suggest that (a) personal environments elicit similar impressions from independent observers, (b) observer impressions show some accuracy, (c) observers rely on valid cues in the rooms to form impressions of occupants, and (d) sex and race stereotypes partially mediate observer consensus and accuracy. Consensus and accuracy correlations were generally stronger than those found in zero-acquaintance research.     

A dog's got personality: a cross-species comparative approach to personality judgments in dogs and humans

This research offers a blueprint for how a cross-species comparative approach can be realized empirically. In a single design, parallel procedures and instruments were used in 2 species, dogs (Canis familiaris) and humans (Homo sapiens), to test whether personality differences exist and can be judged in dogs as accurately as in humans. Personality judgments of humans and dogs were compared on 3 accuracy criteria: internal consistency, consensus, and correspondence. Results showed that, on all 3 criteria, judgments of dogs were as accurate as judgments of humans. These findings are consistent with the evolutionary continuity hypothesis and suggest an important conclusion not widely considered by either personality or animal researchers: Personality differences do exist and can be measured in animals other than humans.     

Video self-portraits: a novel approach to group psychotherapy with young adults

A group therapy model was formulated for exploring the intersubjective processes of adolescents and young adults whose group bonds had been fragmented by their severe emotional illnesses. The model involved having adolescents and young adults who were psychiatric inpatients make video self-portraits; that is, videotapes which focused on various aspects of their emotional pathology. These tapes were then presented before a larger group of nine patients for discussion. The video team method is shown to aid in self-disclosure and facilitate the working through of severe emotional conflicts in this age group. It is an especially useful method with more severely disturbed patients for whom narcissistic self pathology is a prominent feature.     

The ghost in the group room: countertransferential pressures associated with conjoint individual and group psychotherapy

Conjoint individual and group therapy is a commonly used, effective psychotherapeutic treatment. The relationship between the conjoint therapists significantly influences the treatment. This article examines countertransference dilemmas of the group and individual therapists arising from the real and fantasied conjoint relationship. Case examples illustrate specific countertransference dilemmas. Therapists are encouraged to consider the possibility of difficulties with each potential conjoint treatment. Consultation and supervision are recommended to help the conjoint therapists identify and manage countertransference pressures.     

Self-awareness training associated with personality traits and sex: a pilot study

107 volunteers learning Reiki-Do self-awareness techniques participated in this study. Results indicate that personality traits in healthy participants might be affected by specific self-awareness training, such as Reiki-Do, with participants' sex playing an independent role.     

NEO-five factor personality traits as predictors of response to two forms of group psychotherapy

The relationships between patient personality variables and outcome for 107 psychiatric outpatients with complicated grief who completed either interpretive or supportive short-term group therapy were investigated. The personality variables were assessed prior to treatment with the NEO-Five Factor Inventory (NEO-FFI). For patients in both forms of therapy, extraversion, conscientiousness, and openness were directly associated with favorable treatment outcome. In contrast, neuroticism was inversely related to favorable outcome for patients in both forms of therapy. Agreeableness was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but not for those in supportive therapy. The results highlight the importance of assessing patient personality in order to predict response to short-term group therapy. Possible explanations and clinical implications of these findings are discussed.     

Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy

Premature termination from group psychotherapy continues to be a serious problem in the treatment of patients with borderline personality disorder (BPD). Qualitative research is regarded as an important means to shed light upon the complex dynamics leading to dropout. We conducted an interview study with patients having a diagnosis of BPD (n = 8) who dropped out from long-term group psychotherapy as a continuation therapy following intensive day treatment. The group therapists for these patients were interviewed as well (n = 12). The findings suggest the operation of many processes that contribute to dropout. Most significant appeared to be experiences of separation and loss of the day hospital that were not worked through and a failure of the group to regulate and contain the patients' affects. To integrate patients at risk of premature termination it seems necessary to pay attention to the strong negative emotions that they experience in the group. A higher treatment intensity than weekly group sessions may help to promote more beneficial group processes.     

Leadership behavior,group climate and outcome in group psychotherapy: A study of outpatient psychotherapy groups

A recent clinical study of outpatient psychotherapy groups in a community mental health center explored the linkage between group leadership variables, group climate, and outcome. The study involved nine outpatient therapy groups, over 50 group clients, and several group therapists. A repeated measures design involving assessment of clients' outcome and level of functioning, group leadership style, and group climate was used to assess changes over a 6-month period. The findings suggest: 1) a reduction in symptoms and improved functioning for clients; 2) a similarity of perceptions by members and leaders of perceived leadership behaviors and group climate; 3) the presence of direct and indirect influences of group climate and leadership behavior on clients' outcome; and 4) a linkage between leadership behavior and group climate with the theoretical orientation of the group. The findings of the research are discussed in relation to the understanding of specific effects in group psychotherapy and the implications for construction of group psychotherapy theory.The authors would like to thank Robert Dies, Ph.D., for his helpful suggestions in the early phase of this study; Roy MacKenzie, M.D., for permission to use the Group Climate Questionnaire; Diane DePalma, Ph.D., for permission to use the Global Leadership Behavior Index; Chris Boltwood, B.A., for her untiring efforts in administering the instruments and coding and entering the data; and most importantly, the psychotherapy group members and the group therapists for their cooperation in this endeavor—without their help, this clinical study would not have been possible.A version of this paper was presented at the Annual Meeting of the American Group Psychotherapy Association, 1987, New Orleans, Louisiana. Lenore Phipps, R.N., M.S., C.S., was formerly Director, Group Psychotherapy Program at Park Ridge Mental Health Center, Rochester, now in private practice at Guild Medical Center, Norwood, MA 02062.     

Outcomes of inpatient group psychotherapy associated with dispositional and situational affiliativeness

Before and after participating in an intensive three-week program of group psychotherapy, 33 recently rehospitalized male veterans (mean age=42) completed the Symptom Check List-90R and the Profile of Mood States. Prior to this program they also completed a trait affiliativeness measure and later rated their subsequent group therapy sessions for situational affiliativeness. The outcome measures indicated medium to large effect size benefits, which consistently associated positively with both separate and joint measures of trait and situational affiliativeness. The results encourage greater clinical attention to affiliativeness, a construct central to interpersonal theories of personality.This article is based upon a dissertation submitted to the Department of Psychology, Michigan State University, in partial fulfillment of the requirements for the Ph.D. by the senior author.The authors express appreciation for the interest and cooperation of Drs. Bruce Vreeland, Larry Schwartz, Robert Munley, and Hope Conte and the patients of the Veterans Administration Medical Center, Battle Creek, Michigan.     

Brief group psychotherapy for the spousally bereaved: a controlled study.

A consecutive sample of mid- and late-life bereaved spouses were randomly assigned to treatment and no-treatment groups. Two hypotheses were tested: (1) that brief group psychotherapy during the early stages of loss would facilitate adjustment assessed by measures of mental health, positive psychological states, social role, and mourning; and (2) that positive effects would be maximized for subjects who were more distressed psychologically. Although group participants, compared with untreated controls, did over 1 year show modest improvement on role functioning and positive psychological states, overall the study failed to find substantial support for the two major hypotheses. Both experimental and control groups showed improvement over the year, particularly on measures of mental health and mourning. Differential benefit was not observed for the high-risk group.     

Reflections on group psychotherapy with eating-disordered patients

This paper addresses some of the dynamics, resistances, and transference and countertransference considerations in group psychotherapy with eating disordered patients. Several resistances are delineated, including guilt over being helped, the recreation of early problems around control and forced feeding, and withdrawal as a defensive operation. A brief vignette is presented which highlights the demand on the part of the therapist as well as the patient to contain and manage feelings rather than acting on them. Lastly, the author argues that group participation helps the patient to identify, articulate, and accept feelings and to promote assertiveness.This paper is based on a presentation given at the Training Institute for Mental Health on May 11, 1991.