Construct validity of a measure of affective communication in psychotherapy.

Abstract

The present study evaluates the psychometric properties of a therapist measure for evaluating the affective communication created between the patient and therapist during the initial stages of treatment. The Affective Communication Questionnaire (ACQ) was administered to a sample of 81 therapists, each rating a single patient, and principal component analysis indicated the measure has coherent dimensions with strong internal consistency. The construct validity of the ACQ was then established in a sample of 16 therapists rating 73 patients diagnosed with Borderline Personality Disorder (BPD). The measure was found to have a strong relationship to the related constructs of transference, countertransference, and affect experience in predicted directions. The measure also was found to have a modest relationship to independent assessments of patient functioning; most notably more negative affect was significantly related to more odd/eccentric (cluster A) and less anxious/fearful (cluster C) personality disorder symptoms, and greater narrative coherence. Differences in affective communication as a function of treatment type were also evaluated. The clinical and research implications of the findings are discussed.

Patient personality and therapist countertransference

“…Subsequent studies confirmed the results of study by Betan et al [3] in relation to therapist responses towards Cluster B patients, although contradictory results emerged about therapists' responses in relation to Cluster A and Cluster C patients [47,48,50]. Thylstrup and Hesse [48] found that Cluster A patients tend to have very little impact on the therapist, while Meehan et al [50] found that higher Cluster A symptoms were significantly associated with therapists experiencing the relationship with the patient as being predominated by negative affect.…”

“…Several studies have focused on comparing the therapist's reactions in relation to DSM-IV diagnosis at the cluster level (Table 2) [47][48][49][50]51 && ]. The study by Betan et al [3], which can be considered a key article in this field, found significant positive partial correlations between DSM IV Cluster A disorders (paranoid, schizoid and schizotypal personality disorders) and criticized/mistreated therapist responses.…”

“…Thylstrup and Hesse [48] found that Cluster A patients tend to have very little impact on the therapist, while Meehan et al [50] found that higher Cluster A symptoms were significantly associated with therapists experiencing the relationship with the patient as being predominated by negative affect. Regarding therapists' responses toward Cluster C patients, Meehan et al [50] found a significant relationship between Cluster C symptoms and the therapist experiencing the relationship as less enlivened and with less negative affect, while Thylstrup and Hesse [48] found that therapists' responses with this kind of patient were characterized by the presence of negative affect. From our point of view, these results are in part contradictory for several reasons, such as the use of different measures and the differences in samples' compositions but in particular because therapist responses have been investigated in relation to patient DSM diagnosis at the cluster level, ignoring the differences between patients' personality disorders that belong to the same DSM IV cluster.…”

Patient personality and psychotherapist reactions in individual psychotherapy setting: a systematic review

“…Regarding their clinical experience, in four studies (57%), the minimum level of experience was 3 years from psychotherapy licensure (Betan et al, 2005;Colli et al, 2014;Tanzilli et al, 2016Tanzilli et al, , 2017. In one study (Meehan et al, 2012) the experience ranged from 2 to 15 years; in one further study (Genova & Gazzillo, 2018) clinicians had 10.5 (range: 1-38) years of experience; whereas in the remaining study (Dahl et al, 2012) the post-internship experience ranged from 2 to 14 years (mean = 6.5, SD = 3.28).…”

“…Three studies used the DSM in its third (DSM-III-R; APA, 1980) (14%) (Dahl et al, 2012) or fourth edition (DSM-IV-TR; APA, 2010) (29%) (Betan et al, 2005;Meehan et al, 2012 First, Spitzer, Gibbon, Williams, & Benjamin, 1994). Betan et al (2005) asked clinicians to rate as present or absent each criterion of axis II diagnoses of the DSM-IV, and then summed the number of symptoms endorsed for each of PDs in each Cluster.…”