Relational measures in psychotherapy research on process and outcome: a commentary on the studies

Using Benjamin's (2000) Structural Analysis of Social Behavior, we evaluated change in "self-directed" affiliation and autonomy and prediction of treatment response and relapse/recurrence among adult outpatients with recurrent major depressive disorder consenting to acute phase cognitive therapy (A-CT; Beck, Rush, Shaw, & Emery, 1979; N=156); A-CT responders randomized (N=84) to 8 months of continuation phase cognitive therapy (C-CT; Jarrett, 1989; Jarrett et al., 1998; Jarrett & Kraft, 1997) or assessment-only control; and C-CT and control patients entering a 16-month, assessment-only follow-up (N=74). Self-directed affiliation and autonomy increased after A-CT, and C-CT further increased affiliation and autonomy. Affiliation and autonomy did not predict A-CT response, but lower affiliation and higher autonomy pre-A-CT predicted relapse/recurrence post-A-CT. We discuss potential clinical implications of these results and present case examples to illustrate patterns of change.     

Exploring Personality with the Interpersonal Circumplex

The interpersonal circumplex can serve as both companion and guide for those interested in exploring the interpersonal domain of personality. This article offers a relatively nontechnical overview of the model and its various applications in the study of personality. I begin by defining the interpersonal circumplex, its structure and in what sense it is 'interpersonal'. As part of that, I will briefly consider how circumplex measures of personality, such as the Interpersonal Adjective Scales, are typically evaluated for fit to the model. I will next describe applications of the model for exploring both the idiographic (person-centered) and nomothetic (variable-centered) realms of personality. In person-centered research, the circumplex leads to useful ways of summarizing the basic interpersonal features of a given individual. In variable-centered research, the circumplex can help elucidate the essential interpersonal meaning of personality constructs such as traits, problems, and motives. To explain how the circumplex can help us explore personality – idiographically and nomothetically – I will draw on a variety of studies, including several recent studies that extend the model in new ways.     

Circular structure of the MCMI-III personality disorder scales.

Millon's (1987) circular model of personality disorders was examined in a large sample of psychiatric patients (N = 2,366) who completed the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1997) as part of routine assessment after presentation for treatment. Principal components analyses were conducted to identify the first two dimensions in MCMI-III base rate scores, weighted and unweighted raw scores, and nonoverlapping scale scores. Similar analyses were made on these scores when acquiescence was partialled out. Circular plots of the scales were examined against Millon's hypothesized arrangement and the model was tested using confirmatory factor analysis. Results replicated those of Strack, Lorr, and Campbell (1990) with the MCMI-II. Millon's horizontal Impassive-Expressive dimension was recovered in both regular and residual scores but the vertical axis appeared to represent an Impulsivity-Compulsivity dimension rather than the Autonomous-Enmeshed continuum envisioned by Millon. Although scale order followed Millon's predictions for the most part, a number of departures from theoretical expectations were noted and none of the score sets yielded a good fit to the hypothetical structure. Millon's model appears to have promise as a circumplex that can encompass all of the personality disorders but changes are needed to rectify discrepancies between the theory and empirical findings.     

The Epidemiology of Homicide followed by Suicide: A Systematic and Quantitative Review

This systematic review of population based studies of homicide followed by suicide was conducted to examine the associations between rates of homicide‐suicide, rates of other homicides and rates of suicide. The review analysed 64 samples, including the case of an outlier (Greenland) that were reported in 49 studies. There was a significant association between the rates of homicide‐suicide and those of other homicides in studies from the U.S.A. Outside the U.S.A. there was no clear association between homicide‐suicide and other homicide but there was modest but significant association between rates of suicide and homicide‐suicide. Homicide‐suicide appears to be closer in epidemiological terms to homicide than suicide in regions with high rates of homicide and measures to reduce homicide in these regions may also reduce homicide‐suicide.     

Constructing Personality Tests to Meet a Structural Criterion: Application of the Interpersonal Circumplex

ABSTRACT Construct validation of personality tests begins when items are selected according to substantive and structural postulates; nevertheless, substance has generally been emphasized to the neglect of structure. The present approach shows how a structural model—the interpersonal circumplex—could be used to ensure that test items for measures of interpersonal problems (e.g., loneliness, nonassertiveness) faithfully mirror the theoretical characteristics of their constructs. New item statistics are derived with applicability to item analysis and test construction, and the equivalence of item-curve fitting and circumplex scoring is illuminated.     

Assessing the Clinical Competence of Psychology Students Through Objective Structured Clinical Examinations (OSCEs): Student and Staff Views

Objective Structured Clinical Examinations (OSCEs) are a well‐known, reliable, and valid assessment method used across the healthcare sector. In the present study, we applied OSCEs in three units within professional postgraduate psychology courses, with the broad aims of identifying staff and student perceptions of the assessment. At the conclusion of each OSCE, staff and students completed a feedback questionnaire that contained both scaled and open‐ended questions. Results suggest that clinical psychology OSCEs can be stressful for students, but are also well regarded. Both staff and students felt that the OSCEs were realistic, valid, and aligned well with professional practice. Students reported differences in the way in which they prepared for the OSCEs compared with a written exam or other form of assessment, while staff noted that models of OSCE development must be flexible, to adequately assess the objectives of individual units. Further, because they can be a costly exercise, OSCEs need to be applied judiciously within the tertiary sector.     

Evaluating the performance of departments of psychotherapy

Conceptual and practical issues which surround attempts at assessing the efficiency of psychotherapy departments are surveyed and the advantages and disadvantages associated with performance indicators reviewed. The issues of assessing efficiency in general and the selection of appropriate indicators at both national and local levels are discussed. It is concluded that it is possible to find indicators which reflect the value of a psychotherapeutic service to the community within which it is based, and that the identification of a generally agreed set of such parameters is a matter of priority.