Treatment-Disrupting Behaviors during Psychotherapy of Patients With Personality Disorders

Abstract

Psychodynamic personality variables significantly predicted impulsive behaviors, outbursts of anger, and treatment contract violations during psychotherapeutic treatment. The amount of explained variance and incremental value was substantial. These findings support the relevance of psychodynamic assessment in clinical practice. (Journal of Psychiatric Practice. 2011;17:21-34).

Borderline or Schizotypal? Differential Psychodynamic Assessment in Severe Personality Disorders

“…Moreover, our study showed that patients with BPD also display adaptive behavioral patterns and problemsolving strategies, which enable them to develop some sense of individuality and the ability to form more or less reciprocal relationships (also reflected by their marital status). This is consistent with the results of earlier research by Ingenhoven et al, 40 who found a similar psychodynamic profile in patients with BPD. In contrast, our patients with STPD lacked such adaptive capabilities.…”

“…It offers a strength-weakness analysis that can be helpful for meaningful case formulation, treatment indication, and treatment allocation. In a former study by Ingenhoven et al, 40 psychodynamic personality variables, as assesed by the DP, were found to significantly predict impulsive behaviors, outbursts of anger, and treatment contract violations during psychotherapeutic treatment in patients with personality disorders. The amount of explained variance and incremental value was substantial.…”

“…Data on the psychometric properties of the DP indicate good interrater reliability, sufficient internal consistency, good construct validity, and good discriminant validity. 12,39 The DP has been found to predict clinically relevant outcome measures, such as dropping out, therapy interfering behaviors, and outcome of intensive psychotherapy 40,41 Scores on the developmental levels were used to estimate interrater reliability, with 2 studies 42,43 showing sufficient interrater reliability for scoring the various levels of the DP [with quadratically weighted κ 44 values ranging from 0.53 to 0.84 (mean=0.70); and ranging from 0.60 to 0.79 (mean=0.67)]. 39 In addition to the 10 single scores on the DP levels, we computed aggregate psychodynamic variables.…”

Predictive Validity of the MMPI-2 Clinical, PSY-5, and RC Scales for Therapy Disruptive Behavior

“…In accordance with the Borderline Severity Index, 40 the incidents were divided into four categories: impulsive acts, anger outbursts, parasuicidal behaviors, and violations of the treatment contract. The fourth category, contract violations, 7 was included specifically for the inpatient setting.…”

“…Various kinds of diagnostic instruments have been developed to fill this knowledge gap. For instance, Ingenhoven et al 7 investigated patients' psychodynamic characteristics as assessed with the Developmental Profile (DP). 8 DP variables were used to predict impulsive acts, anger outbursts, parasuicidal behaviors, and contract violations.…”