The aim of this study is to explore the relationship between level of personality organization and type of personality disorder as assessed with the categories in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and the emotional responses of treating clinicians. We asked 148 Italian clinicians to assess 1 of their adult patients in treatment for personality disorders with the Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and the Personality Diagnostic Prototype (PDP; Gazzillo, Lingiardi, & Del Corno, 2012) and to complete the Therapist Response Questionnaire (TRQ; Betan, Heim, Zittel-Conklin, & Westen, 2005). The patients' level of overall personality pathology was positively associated with helpless and overwhelmed responses in clinicians and negatively associated with positive emotional responses. A parental and disengaged response was associated with the depressive, anxious, and dependent personality disorders; an exclusively parental response with the phobic personality disorder; and a parental and criticized response with narcissistic disorder. Dissociative disorder evoked a helpless and parental response in the treating clinicians whereas somatizing disorder elicited a disengaged reaction. An overwhelmed and disengaged response was associated with sadistic and masochistic personality disorders, with the latter also associated with a parental and hostile/criticized reaction; an exclusively overwhelmed response with psychopathic patients; and a helpless response with paranoid patients. Finally, patients with histrionic personality disorder evoked an overwhelmed and sexualized response in their clinicians whereas there was no specific emotional reaction associated with the schizoid and the obsessive-compulsive disorders. Clinical implications of these findings were discussed.

This article reviews the development of the second edition of the Psychodynamic Diagnostic Manual, the PDM-2. We begin by placing the PDM in historical context, describing the structure and goals of the first edition of the manual, and reviewing some initial responses to the PDM within the professional community. We then outline 5 guiding principles intended to maximize the clinical utility and heuristic value of PDM-2, and we delineate strategies for implementing these principles throughout the revision process. Following a discussion of 2 PDMderived clinical tools-the Psychodiagnostic Chart and Psychodynamic Diagnostic Prototypes, we review initial research findings documenting the reliability, validity, and clinical value of these 2 measures. Finally, we discuss changes proposed for implementation in PDM-2 and the potential for an updated version of the manual to enhance clinical practice and research during the coming years.

Many studies document the efficacy of psychotherapy for acute syndromes such as depression, but less is known about personality change in patients treated for personality pathology. The Shedler-Westen Assessment Procedure (SWAP-200; Westen & Shedler, 1999a, 1999b) is an assessment tool that measures a broad spectrum of personality constructs and is designed to bridge the gap between the clinical and empirical traditions in personality assessment. In this article, we demonstrate the use of the SWAP-200 as a measure of change in a case study of a patient diagnosed with borderline personality disorder. We collected assessment data at the start of treatment and after 2 years of psychotherapy. The findings illustrate the personality processes targeted in intensive psychotherapy for borderline personality.

The present study sought to further understand patients' crying experiences in psychotherapy. We asked 64 clinicians to randomly request one patient in their practice to complete a survey concerning crying in psychotherapy as well as a measure of therapeutic alliance. All clinicians provided information regarding their practice and patient diagnostic information. Fifty-five (85.93%) patients cried at least once, and 18 (28.1%) had cried during their most recent session. Patients' frequency of crying episodes in therapy was negatively related with psychotic level of personality organization, while patients' tendency to feel more negative feelings after crying was positively related to lower levels of personality organization. Patients' feeling more in control after crying was positively related with an interpersonal therapeutic approach, while patients' perception of therapists as more supportive after crying was positively related to a psychodynamic approach. Patients' tendency to experience more negative feelings after crying was significantly related with both lower levels of personality organization and patients' perception of the therapeutic alliance as weak. In regard to their most recent crying event in treatment, therapeutic alliance was related to gaining a new understanding of experience not previously recognized by the patient. Further, patients' experiences of having never told anyone about their experience related to a crying episode, as well as their realization of new ideas and feeling of having communicated something that words could not express was positively related to the goal dimension of alliance. Patients' perception of crying as a moment of genuine vulnerability, greater feelings of self-confidence and self-disclosure as well as having had a therapist response that was compassionate and supportive, was positively related with the bond dimension of alliance. Clinical implications and future research directions regarding patient crying experiences in psychotherapy are discussed. (PsycINFO Database Record

The aim of this paper is to present a theoretical and empirical overview of the hypothesis that patients' behavior in psychotherapy can be understood as an expression of their efforts to disprove their pathogenic beliefs by testing them in the therapeutic relationship. According to Control-Mastery Theory (CMT;Gazzillo, 2016;Silberschatz, 2005;Weiss, 1986Weiss, , 1994, psychopathology stems from unconscious pathogenic beliefs developed in response to early traumas. Pathogenic beliefs associate the achievement of healthy goals with a variety of unconsciously perceived dangers. Thanks to the inborn human motivation to adapt to reality and to the power of adaptive unconscious mental functioning, patients come to therapy with a unconscious plan to overcome their pathogenic beliefs by testing them with their therapists. Tests are consciously or unconsciously devised actions aimed at disproving pathogenic beliefs. CMT describes two broad categories of tests: transference tests and passive-into-active tests. Tests require specific responses from the therapist to be passed. When therapists pass patients' tests, patients feel safer and may make therapeutic progress; when tests are failed, patients feel endangered and may get worse. Consistent with CMT assumptions, studies on testing have shown that a therapist passing a patient's tests is associated with immediate positive effects on the patient, but more studies are needed.