Brief Communications: Interrater Reliability for Kernberg's Structural Interview for Assessing Personality Organization

Abstract

Interrater reliability is considered a precondition for the validity of theoretical models and their corresponding diagnostic instruments. Studies have documented good interrater reliability for structured interviews measuring personality characteristics on a descriptive-phenomenological level but there is little research on reliability of assessment procedures on a structural level. The current study investigated the interrater reliability of the structural interview (SI) designed to assess neurotic, borderline, and psychotic personality organization according to Kernberg. Videotaped SIs of 69 psychiatric patients were randomly and independently rated by two out of three trained psychologists. Agreement between rater pairs was expressed as square weighted kappa (K(sw), 95% CI). Results indicate satisfactory interrater reliability with respect to Kernberg's tripartite classification (K(sw) = 0.42, 95% CI 0.07 to 0.77). Subdivision of the borderline category or introduction of intermediate subcategories to the tripartite system did not significantly affect reliability (K(sw) = 0.55, 95% CI 0.30 to 0.80; K(sw) = 0.59, 95% CI 0.34 to 0.84, respectively). The conclusion is that trained clinicians can reliably assess structural personality organization using the SI. Refining the nosological system adding subcategories did not reduce reliability.

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“…Although we acknowledge that the Kappa coefficient has some bottlenecks, such as, Kappa value can be affected by skewed distributions of categories and the bias problem [65], and the kappa value for three or more categories is considered un-interpretable [66]. Despite the difficulties, it is the most extensively used coefficient for summarizing inter-rater agreement [67][68][69][70][71].…”

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“…Development of case formulation methods using novel technologies 8. Use of case formulation for the study of psychotherapy moderators and mechanisms of change Armelius et al, 1990;Critchfield et al, 2017;Dinger et al, 2014 ;Ingenhoven et al, 2009 ;Kuyken et al, 2005 ;Pascual-Leone, 2018 ;Völlm, 2014Emmelkamp et al, 1994Ghaderi, 2006 ;Kramer et al, 2014 ;Schulte et al, 1992Perry et al, 1989Minoudis et al, 2013Eells et al, 2005Chi, 2006Caspar et al, 2004Johansson et al, 2012Boritz et al, 2018Crits-Christoph et al, 1993 ;Silberschatz et al, 1986 ;Westerman et al, 1995 ;Zufferey et al, 2019. INDIVIDUALIZING PSYCHOTHERAPY RESEARCH DESIGNS 45 Table 2 Two clients with borderline personality disorder with their own 10 self-critical words, as uttered towards the Self in an experiential two-chair dialogue "Monica", 22 years "Desiree", 26 years…”

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“…Les symptômes s'y manifestent suite aux clarifications et confrontations du thérapeute. De plus, au cours de cet entretien, le thérapeute doit porter attention à l'émergence de mécanismes de défense, aux indicateurs de la diffusion de l'identité et aux distorsions de la réalité (Ingenhoven et al, 2009). Ainsi, le SAI requiert ainsi une grande connaissance du modèle psychanalytique et particulièrement du modèle de Kernberg.…”