Journeys through the valley of death: multimethod psychological assessment and personality transformation in long-term psychotherapy

The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is based on the assumption that an in-depth understanding of clients' underlying emotional, personality, and interpersonal patterns will facilitate their treatment. In this article I show how such an understanding can be achieved through multimethod psychological assessment, and how useful such information can be in long-term psychotherapy with high-achieving, successful clients who struggle with forming and maintaining intimate relationships. Such treatments are extremely difficult, because when these clients attach to their psychotherapists, many of them temporarily become more symptomatic. I illustrate these points with a detailed account of my long-term therapy with a resilient but highly traumatized young man. Repeated use of the Minnesota Multiphasic Personality Disorder-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach with my client helped guide us in our work, and also helped create an important therapeutic "opening" into the underlying traumatic material. This and other experiences have convinced me that it is extremely useful for psychologists to have training in both assessment and psychotherapy.     

Using conditional discrimination training to produce emergent relations between coins and their values in children with autism

The current study evaluated the effects of conditional discrimination (listener) training with coins on the emergence of novel stimulus relations, textual behavior, tacts, and intraverbals. Two preschoolers with autism were taught 3 relations among coins, their names, and values. After initial training, 4 relations emerged for the first participant and 7 for the second participant, suggesting that this technology can be incorporated into educational curricula for teaching prerequisite money skills to children with autism.     

Enhancing retention through reconsolidation: negative emotional arousal following retrieval enhances later recall

When information is retrieved from memory, it enters a labile state rendering it amenable to change. This process of reconsolidation may explain, in part, the benefits that are observed in later retention following retrieval of information on an initial test. We examined whether the benefits of retrieval could be modulated by an emotional event occurring after retrieval. Participants studied Swahili-English vocabulary pairs. On a subsequent cued-recall test, each retrieval was followed by a blank screen, a neutral picture, or a picture inducing negative affect. Performance on a final cued-recall test was best for items whose initial retrieval was followed by negative pictures. This outcome occurred when a negative picture was presented immediately after (Experiment 1) or 2 s after (Experiment 2) successful retrieval, but not when it was presented after restudy of the vocabulary pair (Experiment 3). Postretrieval reconsolidation via emotional processing may enhance the usual positive effects of retrieval.     

Does easily learned mean easily remembered?: it depends on your beliefs about intelligence

Because numerous studies have shown that feelings of encoding fluency are positively correlated with judgments of learning, a single dominant heuristic, easily learned = easily remembered (ELER), has been posited to explain how people interpret encoding fluency when assessing their own memory. However, the inferences people draw from feelings of encoding fluency may vary with their beliefs about why information is easy or effortful to encode. We conducted two experiments in which participants studied word lists and then predicted their future recall of those items. Results revealed that subjects who viewed intelligence as fixed, and who tended to interpret effortful encoding as indicating that they had reached the limits of their ability, used the ELER heuristic to make judgments of learning. However, subjects who viewed intelligence as malleable, and who tended to interpret effortful encoding as indicating greater engagement in learning, did not use the ELER heuristic and at times predicted greater memory for items that they found more effortful to learn.     

The MMPI–2–RF Personality Psychopathology Five (PSY–5–RF) Scales: Development and Validity Research

This article describes the development, internal psychometric, and external validation studies on scales designed to measure the Personality Psychopathology Five (PSY–5) from MMPI–2 Restructured Form (MMPI–2–RF) items. Diverse and comprehensive data sets, representing various clinical and nonclinical populations, were classified into development and validation research samples. Item selection, retention, and exclusion procedures are detailed. The final set of PSY–5–RF scales contain 104 items, with no item overlap between scales (same as the original MMPI–2 PSY–5 scales), and no item overlap with the Demoralization scale. Internal consistency estimates are comparable to the longer MMPI–2 PSY–5 scales. Appropriate convergent and discriminant validity findings utilizing various self-report, collateral rating, and record review data are reported and discussed. A particular emphasis is offered for the unique aspects of the PSY–5 model: psychoticism and disconstraint. The findings are connected to the broader PSY–5 literature and the recommended review of systems (Harkness, Reynolds, & Lilienfeld, this issue) presented in this series of articles.     

The MMPI–2 Restructured Form Personality Psychopathology Five Scales: Bridging DSM–5 Section 2 Personality Disorders and DSM–5 Section 3 Personality Trait Dimensions

This study examined in a college sample and a sample of non-treatment-seeking, trauma-exposed veterans the association between the MMPI–2 Restructured Form (MMPI–2–RF) Personality Psychopathology Five (PSY–5) Scales and DSM–5 Section 2 personality disorder (PD) criteria, the same system used in DSM–IV–TR, and the proposed broad personality trait dimensions contained in Section 3 of DSM–5. DSM–5 Section 2 PD symptoms were assessed using the SCID–II–PQ, and applying a replicated rational selection procedure to the SCID–II–PQ item pool, proxies for the DSM–5 Section 3 dimensions and select facets were constructed. The MMPI–2–RF PSY–5 scales demonstrated appropriate convergent and discriminant associations with both Section 2 PDs and Section 3 dimensions in both samples. These findings suggest the MMPI–2–RF PSY–5 scales can serve both conceptually and practically as a bridge between the DSM–5 Section 2 PD criteria and the DSM–5 Section 3 personality features.     

Cognitive Complexity and Dissociative Identity Disorder

Thirteen patients with dissociative identity disorder (DID), 13 with other mental disorders, and 10 nondiagnosed comparison participants were given individual grids. Results showed that displaying alternate personalities did not portend a more multidimensional level of thinking. Instead, the nonclinical comparison group had the greater degree of complexity in comparison to both clinical groups. A notable clinical observation was that DID patients, as compared to non-DID participants, had a greater understanding and speed in completing the grid. Findings are discussed in terms of the advantages of personal construct theory for conceptualizing the construct of dissociation.     

Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust

Abstract

Research evidence suggests Therapeutic Assessment positively affects clients with problems in living, including clients with personality disorders, who are typically quite resistant to change. Importantly, this change takes place quickly, in relatively few sessions. This article draws on a relatively new evolutionary-based theory of epistemic trust (ET) and epistemic hypervigilance (EH) as a lens to plausibly explain the efficacy of TA, and especially its influence on PD clients' alliance and motivation for subsequent psychotherapy (Fonagy, Luyten, &; Alison, 2015 Fonagy, P., Luyten, P., &; Allison, E. (2015). Epistemic petrification and the restoration of epistemic trust: A new conceptualization of borderline personality disorder and its psychosocial treatment. Journal of Personality Disorders, 29, 575–609.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). ET is the willingness to take in relevant interpersonally transmited information and it is essential to the immediate success of psychotherapy and its long-term impact. The collaborative, intersubjective framework of TA and many of its specific techniques might be understood as highly relevant to restoring ET in clients, especially those with PD. We close by discussing implications for psychological assessment, psychotherapy, and research.     

The Many Faces of Empathy in Experiential,Person-Centered,Collaborative Assessment

Paul Lerner was an amazing clinician and teacher, and he wrote that empathy was the “heart” of his particular approach to psychological assessment. In this article, I discuss 3 meanings of empathy: (a) as an information-gathering tool, (b) as an interpersonal process, and (c) as a healing element in human interactions. I then demonstrate how each of these meanings of empathy is exemplified in Lerner's written work and in collaborative and therapeutic assessment.     

Therapeutic assessment of a man with "ADD"

In this article I present the first published complete case study of a psychological assessment done by the methods of Therapeutic Assessment. A client-therapist pair had been working together for several years but felt "stuck" in the treatment. The man had been previously diagnosed with attention deficit disorder (ADD) and sought help for disorganization and difficulties in romantic relationships. The therapist asked for diagnostic clarification but gradually revealed a deeper confusion about how to work with the client. Through the collaborative process of the assessment, the client gradually concluded that he did not have ADD, and he and the therapist reached a joint understanding of their next steps in treatment. This case illustrates how collaborative psychological assessment (a) can help clients revise their "stories about themselves and the world" and (b) provides an effective, non-threatening way for a consultant to intervene in a client-therapist system that has reached an impasse.