Combined therapy with borderline and narcissistic inpatients at the cassel hospital

An account is given here of a rather unorthodox approach to psychodynamic therapy with Borderline patients in part of the therapeutic community at the Cassel Hospital. ‘Combined therapy’ here refers to the setting in which one therapist sees patients in groups and individual sessions concurrently. The paper demonstrates the manner in which this approach brings to the fore the massive destructiveness and rage which so often lies at the core of these patients' difficulties. This is done by describing the development of the group over its first nine months. The therapist comes to be split in the patient's perception, the group sessions representing separation in all its most hated aspects rather than as a prerequisite for differentiation and growth. The resultant rage and destructiveness threaten to render the group unworkable and dangerous. The individual sessions, by contrast, represent a fantasy of being regressed and at one with the ideal mother. It is my belief that these difficulties can be contained only within a therapeutic community. The strength of this approach lies in the vivid reconstruction of a central conflict for these patients and corresponding potential for working through difficulties in the area of separation and individuation. It is also particularly effective in bringing the therapeutic community alive within the therapy. The discussion attempts to address some of the complex theoretical issues raised by the transformation of the transference in both settings which occurs when they are used together and with the same therapist.     

Genotype-environment interaction in personality development: identical twins reared apart

The focus of this study is to identify specific genotype-environment (GE) interactions as they contribute to individual differences in personality in later life. In behavioral genetics, GE interaction refers to the possibility that individuals of different genotypes may respond differently to specific environments. A sample of 99 pairs of identical twins reared apart, whose average age is 59 years, has been studied as part of the Swedish Adoption/Twin Study of Aging (SATSA). Hierarchical multiple regression was used to detect interactions between personality and environmental measures after the main effects of genotype and environment were removed. Analyses yield evidence for 11 significant interactions that provide the first evidence for GE interaction in human development using specific environmental measures. Thus, in addition to the main-effect contributions of heredity and environment, GE interactions contribute to individual differences in personality as measured in the second half of the life course.     

Get Over It! A Multilevel Threshold Autoregressive Model for State-Dependent Affect Regulation

Intensive longitudinal data provide rich information, which is best captured when specialized models are used in the analysis. One of these models is the multilevel autoregressive model, which psychologists have applied successfully to study affect regulation as well as alcohol use. A limitation of this model is that the autoregressive parameter is treated as a fixed, trait-like property of a person. We argue that the autoregressive parameter may be state-dependent, for example, if the strength of affect regulation depends on the intensity of affect experienced. To allow such intra-individual variation, we propose a multilevel threshold autoregressive model. Using simulations, we show that this model can be used to detect state-dependent regulation with adequate power and Type I error. The potential of the new modeling approach is illustrated with two empirical applications that extend the basic model to address additional substantive research questions.     

Assessing the impact of group treatment for aggressive inpatients

The purpose of this research was to determine if psychodynamic group psychotherapy decreases the occurrence of physical assault by male group members. The design of the study was a randomized clinical trial. Patients assigned to the control group received the customary clinical care. Patients assigned to the Group Therapy attended a psychodynamic psychotherapy group to help them cope with their aggressive impulses. Both quantitative and qualitative measures were used. Group members showed decreased expression of anger at followup, increased effort to control anger at followup, and decline in aggressive behavior. Control subjects demonstrated no change in level of angry feelings, increased expression of anger at follow-up, decrease in effort to control anger at follow-up, and no change in aggressive behavior. A model for conducting a psychodynamic psychotherapy group for assaultive men was developed which describes process and content aspects as well as leader interventions by group phase.     

Genetic mediation of the relationship between social support and psychological well-being.

This study assessed genetic and environmental influences on the association between social support and psychological functioning using the combined adoption/twin design from the Swedish Adoption/Twin Study of Aging. A subsample of 424 twin pairs, 50 years and older, was used: 64 pairs of identical twins reared apart, 95 pairs of identical twins reared together, 132 pairs of fraternal twins reared apart, and 133 pairs of fraternal twins reared together. Multivariate model-fitting analyses indicated that the relationship between the perceived adequacy of social support and psychological well-being (depression and life satisfaction) was mediated in part by genetic factors.     

On Standardizing Within-Person Effects: Potential Problems of Global Standardization

Person-mean centering has been recommended for disaggregating between-person and within-person effects when modeling time-varying predictors. Multilevel modeling textbooks recommended global standardization for standardizing fixed effects. An aim of this study is to evaluate whether and when person-mean centering followed by global standardization can accurately estimate fixed-effects within-person relations (the estimand of interest in this study) in multilevel modeling. We analytically derived that global standardization generally yields inconsistent (asymptotically biased) estimates for the estimand when between-person differences in within-person standard deviations exist and the average within-person relation is nonzero. Alternatively, a person-mean-SD standardization (P-S) approach yields consistent estimates. Our simulation results further revealed (1) how misleading the results from global standardization were under various circumstances and (2) the P-S approach had accurate estimates and satisfactory coverage rates of fixed-effects within-person relations when the number of occasions is 30 or more (in many conditions, performance was satisfactory with 10 or 20 occasions). A daily diary data example, focused on emotional complexity, was used to empirically illustrate the approaches. Researchers should choose standardization approaches based on theoretical considerations and should clearly describe the purpose and procedure of standardization in research articles.