Participants were 54 clients with serious psychiatric disorders and 21 clinical case managers. Clients' serious psychiatric disorders included Axis I diagnoses, such as schizophrenia and bipolar disorder. This study examined how attachment states of mind of both clients and case managers influenced the effectiveness of therapeutic relationships and client functioning. Client and case manager attachment states of mind interacted in predicting the working alliance and client functioning. Specifically, clients who were more deactivating with respect to attachment had better alliances and functioned better with less deactivating case managers, whereas clients who were less deactivating worked better with more deactivating case managers. These findings highlight the importance of clinicians and clients being matched in ways that balance their interpersonal and emotional strategies.
Thirty-four clients with serious psychopathological disorders were videotaped solving interpersonal problems with significant others or with case managers. Differential reliance on dismissing states of mind was examined in relation to behavioral ratings of clients during the interactions, and in relation to changes in clients' and partners' reports of feelings. Clients who relied more on dismissing strategies showed greater rejection of significant others, but not of case managers, compared with clients who relied more on preoccupied strategies. The partners of dismissing clients reported greater sadness following problem-solving interactions than the partners of preoccupied clients. Clients who relied more on dismissing strategies spent less time on task when interacting with their case managers than clients who relied more on preoccupied strategies, and reported more confusion following these interactions. These findings suggest that treatment is likely to provide a particularly challenging context for adults with dismissing states of mind.
Thirty-four clients with serious psychopathological disorders were videotaped solving interpersonal problems with significant others or with case managers. Differential reliance on dismissing states of mind was examined in relation to behavioral ratings of clients during the interactions, and in relation to changes in clients' and partners' reports of feelings. Clients who relied more on dismissing strategies showed greater rejection of significant others, but not of case managers, compared with clients who relied more on preoccupied strategies. The partners of dismissing clients reported greater sadness following problem-solving interactions than the partners of preoccupied clients. Clients who relied more on dismissing strategies spent less time on task when interacting with their case managers than clients who relied more on preoccupied strategies, and reported more confusion following these interactions. These findings suggest that treatment is likely to provide a particularly challenging context for adults with dismissing states of mind.
Comorbidity of psychotic and dissociative disorders often is not reported. This 38 year-old female with a history of schizophrenic symptoms displayed evidence of dissociative identity disorder (DID) during admission to an inpatient psychiatric unit. The case illustrates how the presence of a dissociative disorder may influence the presentation of a co-morbid psychosis. The historical association and differential diagnosis between DID and schizophrenia is described. Implications of various treatment approaches for patients exhibiting dissociation in the context of psychosis are discussed. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: ]
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