Defense mechanisms and self-reported violence toward partners and strangers

We examined the relationship between defense mechanisms and self-reported violence toward partners and toward strangers in a sample of college student men. Fifty men completed the Thematic Apperception Test (TAT; Murray, 1943) and the Conflict Tactics Scale (CTS; Straus, 1979), a self-report measure of strategies (including violence) for resolving conflicts with partners and strangers. The TAT responses were coded for defense mechanisms with the Defense Mechanisms Manual (Cramer, 1991b). The relative use of identification was negatively correlated (r = -.49, p <.001), and the relative use of projection was positively correlated (r =.49, p <.001) with the most extreme CTS report of violence toward partners. The relative use of identification was negatively correlated with the most extreme CTS report of violence toward strangers (r = -.34, p <.05). The relative use of denial was positively correlated with the most extreme CTS report of violence toward strangers (r =.32, p <.05).     

Convergent Validity of the Early Memory Index in Two Primary Care Samples

Karliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a suburban primary care clinic (Study 2). Patients provided early memory narratives and completed self-report measures of psychopathology, trauma, and health care utilization. In both studies, lower scores on the Mental Health scale and higher scores on the Traumatic Experiences scale were related to higher scores on measures of psychopathology and childhood trauma. Less consistent associations were found between the Mental Health and Traumatic Experiences scores and measures of health care utilization. The Narrative Coherence scale showed inconsistent relationships across measures in both samples. In analyses assessing the overall fit between hypothesized and actual correlations between EMI scores and measures of psychopathology, severity of trauma symptoms, and health care utilization, the Mental Health scale of the EMI demonstrated stronger convergent validity than the EMI Traumatic Experiences scale. The results provide support for the convergent validity of the Mental Health scale of the EMI.     

Pediatric Symptom Checklist Ratings by Mothers with a Recent History of Intimate Partner Violence: A Primary Care Study

Screening for psychosocial problems is an effective way to identify children who need further evaluation, and many brief, psychometrically strong measures exist for this purpose. More research is needed, however, about the performance of these measures in special populations who are familiar to primary care settings. The purpose of this study was to examine and compare maternal ratings on the Pediatric Symptom Checklist (PSC) between low-income, urban mothers who had suffered intimate partner violence (IPV) in the past year (n = 23) and a demographically-matched comparison group of mothers (n = 23). Victims of violence rated their children as having significantly more problems in a number of categories (Total PSC Score, Externalizing, and Internalizing) than did mothers in the comparison group. The PSC shows promise as an adequate screening tool for psychosocial problems in the children of women who have suffered IPV, but more research is needed.     

“I Fired My Last Doctor for Not Taking Me Seriously”: Collaborating With a Difficult Medical Patient in a Multidisciplinary Primary Care Facility

We present the case of a multidisciplinary primary care assessment of a 32-year-old woman with multiple medical and psychological complaints. Following the collaborative care model, this assessment was conducted by a team consisting of a clinical health psychologist, Dr. J. L. Skillings, and a family physician, Dr. W. J. Murdoch. We describe the primary care environment in which this referral was made including the methods that were utilized to insure a successful professional collaboration. We report the results and recommendations from a comprehensive biopsychosocial assessment; we place emphasis on the psychological diagnosis and pain symptoms. We also describe the feedback session in which the assessment results were provided to the patient and her spouse by both physician and psychologist. Multiperspective commentary about the assessment is offered by the patient and her husband as well as the physician and psychologist assessors.     

The mental functioning axis of the psychodynamic diagnostic manual: an adolescent case study

We describe the assessment of a troubled adolescent boy to demonstrate the use of the Shedler-Westen Assessment Profile for Adolescents (Westen, Dutra, & Shedler, 2005) and the Social Cognition and Object Relations Scale-Global (Westen, 1995) to formulate the Mental Functioning for Children and Adolescents Axis (MCA) of the Psychodynamic Diagnostic Manual (PDM Task Force, 2006). The assessment made possible a meaningful psychodynamic therapy.     

Reliability and validity of rorschach aggression variables with a sample of adjudicated adolescents

In this investigation, we assessed the reliability and validity of 5 Rorschach aggression variables (AG, A1, A2, AgC, and AgPast) in a sample of adjudicated, mostly conduct-disordered adolescents (N = 150). More specifically, we assessed the interrelationships of Rorschach aggression variables using correlational analyses and factor analysis and assessed the relationships between Rorschach variables and a measure of aggressive potential (the Manifest Aggression scale from the Jesness Inventory; Jesness, 1996) as well as a measure of real-world aggression/violence (the Violence Rating Scale-Revised [VRS-R]; Young, Justice, & Erdberg, 1997). Two of Gacono and Meloy's (1994) Rorschach aggression variables were dropped from the study (AgPot and SM) due to a low frequency of occurrence. All 5 of the remaining Rorschach aggression variables and the VRS-R were rated reliably, and factor analysis of the Rorschach variables revealed 2 distinct factors accounting for 71% of the total variance. Only the AgC variable concurrently predicted aggressive potential and aggressive/violent behavior. Results lend further support for the inclusion of AgC in the Comprehensive System's (Exner, 1993) list of Special Scores.     

"I fired my last doctor for not taking me seriously": collaborating with a difficult medical patient in a multidisciplinary primary care facility

We present the case of a multidisciplinary primary care assessment of a 32-year-old woman with multiple medical and psychological complaints. Following the collaborative care model, this assessment was conducted by a team consisting of a clinical health psychologist, Dr. J. L. Skillings, and a family physician, Dr. W. J. Murdoch. We describe the primary care environment in which this referral was made including the methods that were utilized to insure a successful professional collaboration. We report the results and recommendations from a comprehensive biopsychosocial assessment; we place emphasis on the psychological diagnosis and pain symptoms. We also describe the feedback session in which the assessment results were provided to the patient and her spouse by both physician and psychologist. Multiperspective commentary about the assessment is offered by the patient and her husband as well as the physician and psychologist assessors.     

Object relations and defense mechanisms of a psychopathic serial sexual homicide perpetrator: a TAT analysis

The case of a 24-year-old African American man who committed serial sexual homicide and who met criteria (Hare, 1991) for psychopathy is presented. His Thematic Apperception Test (Murray, 1943) responses were used to code key aspects of personality organization--object relations and defense mechanisms--via the Social Cognition and Object Relations Scale (Westen, Lohr, Silk, & Kerber, 1989) and the Defense Mechanisms Manual (Cramer, 1991), respectively. Severe object relations pathology and a reliance on the defense mechanism of immature projection and immature denial are noted. Findings are relatively consistent with previous psychodynamic Rorschach studies of psychopathic sexual homicide perpetrators (Gacono, Meloy, & Bridges, 2000; Meloy, Gacono, & Kenney, 1994).     

Construct Validity of the Relationship Profile Test: Correlates of Overdependence,Detachment, and Healthy Dependency in Low Income Urban Women Seeking Medical Services

Four categories of paintings (N = 200), done by schizophrenic patients, art students, and education students were rated by judges (N = 13) as to whether the painter was schizophrenic or normal. There was significant agreement in correctly identifying paintings, but the percent correct, greater than chance, was only 9.99%. Judges did best on paintings with “human content.” Intelligence scores were related to correct identification of two paintings, while art experience related to proportion was judged schizophrenic for all four paintings. Stepwise regression analysis suggested that intelligence scores were artifactually related to painting scores but art experience was not.