Personality and Symptom Change in Treatment-Refractory Inpatients: Evaluation of the Phase Model of Change Using Rorschach, TAT, and DSM-IV Axis V

Abstract

In this study, we examined global treatment outcomes during 16 months of intensive, psychodynamic treatment for 77 inpatients suffering from treatment-refractory disorders. Hypotheses based on the phase model of treatment change (Howard, Lueger, Maling, & Martinovich, 1993; Howard, Moras, Brill, Martinovich, & Lutz, 1996) were supported in the study results. Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis V scales assessing behavioral functioning demonstrated large and medium effect size change, whereas stable, enduring personality functioning assessed by psychoanalytic Rorschach scales and the Social Cognition and Object Relations Scale (Westen, 1995) for the Thematic Apperception Test (Murray, 1943) demonstrated small and medium effect size change. We also report assessment of reliable change index and clinical significance. The ecological validity of Rorschach measures is supported by significant validity coefficients (in the hypothesized directions) between implicit measures of personality functioning and behavioral ratings.

Investigation of the Phase Model of Psychotherapy Across Therapeutic Orientations: Are Different Approaches Actually All That Different?

“…The majority of previous research regarding the phase model indicates that the progression through the stages follows a largely invariant sequence (Fowler et al, 2004;Schwartz, 1997). These findings are in contrast to the current ones which indicate that rehabilitation appears to occur simultaneously with remediation, thus casting doubt on the invariance of the phases, as well as the notion that each successive phase cannot start without the previous one concluding.…”

Relationship between the Social Cognition and Object Relations Scale (SCORS) and attachment style in a clinical sample

“…Additionally, we were not able to use two of the SCORS variables (e.g., EIM and ICS) in the present study due to poor reliability. While the SCORS has been repeatedly shown to be a reliable measure (Eudell-Simmons, Stein, DeFife, & Hilsenroth, 2005;Fowler, Hilsenroth, & Handler, 1995;Fowler et al, 2004;Porcerelli, Cogan, & Hibbard, 1998;Stein et al, 2007), reliability for these two variables were questionable in the present study and thus unavailable for use. This is particularly unfortunate with regards to EIM, which we expected would differ considerable across attachment types.…”

“…They suggest that attachment styles are 'enduring characteristics that are not easily modifi ed ' (p. 1062). Prior research with the SCORS, however, has shown sensitivity to change in internal representations (Fowler, Ackerman, Speanburg, Bailey, & Blagys, 2004;Porcerelli, Shahar, Blatt, Ford, Mezza, & Greenlee, 2006). It is possible that explicit self-report measures may be particularly useful as assessment tools of more stable personality characteristics, while narrative-based methods like the SCORS may have excellent utility for understanding change as a function of therapy over time.…”

A dynamic assessment of offender risk, needs, and strengths in a sample of pre‐release general offenders

“…Relevant examples indicate the occurrence of positive therapeutic changes for aggression, self-esteem, emotional investment in relationships or attachment, hostility, decision making, risk taking, and drug abuse for inpatient and outpatient adults (Fowler et al, 2004;Gossop, Marsden, Stewart, & Treacy, 2002;Prendergast, Farabee, Cartier, & Henkin, 2002). It stands to reason that positive dynamic variable change through treatment is also possible for offenders, and that such change may in fact reduce rates of recidivism.…”