Severe Interpersonal Problems Research Articles

The Interplay of Epistemic Trust, Defensive Mechanisms, Interpersonal Problems, and Symptomatology: An Empirical Investigation

Epistemic trust has emerged as a promising construct in understanding psycho(patho)logical functioning. However, its interplay with other dimensions that may contribute to developing specific symptom patterns remains underexplored. This study sought to investigate how epistemic trust, mistrust, and credulity relate to relational difficulties, defense mechanisms, and psychological symptoms to enrich the comprehension of their impact on mental health. A sample of 385 Italian individuals (60 % females and 40 % males, Mage = 28.2, SDage = 9.6, 18–65 years) completed an online survey including self-report questionnaires: Epistemic Trust, Mistrust, and Credulity Questionnaire, Defense Mechanisms Rating Scale-Self-Report-30, Inventory of Interpersonal Problems-32, and Brief Symptom Inventory. Results showed that epistemic disruptions were associated with severe interpersonal problems, more primitive defense mechanisms, and greater levels of psychopathology. Moreover, epistemic mistrust and lower defensive functioning strongly predicted higher levels of symptomatology, underscoring their detrimental effect on processes underlying mental health. These findings highlight the critical role of epistemic disruptions as risk factors for psychological distress, offering vital insights into the dynamic mechanisms underpinning mental health, as well as implications for intervention protocols and clinical practice.

Childhood Trauma and Panic Disorder: The Impact of History of Child Abuse on Illness Severity and Treatment Response.

Patients who have experienced child abuse often have complex clinical presentations; whether a history of child abuse (HCA) affects psychotherapy outcomes is unclear. The authors examined relationships between HCA, clinical baseline variables, and change in these variables after three different psychotherapies for panic disorder (PD). Two hundred adults with PD (with or without agoraphobia) were randomly assigned to one of three treatments across two sites: panic-focused psychodynamic psychotherapy (PFPP), cognitive-behavioral therapy (CBT), or applied relaxation training (ART). Differences in demographic and clinical variables between those with and without HCA were compared. The primary analysis addressed odds of meeting clinical response criteria on the Panic Disorder Severity Scale (PDSS) between treatments, as moderated by HCA. This effect was examined via continuous outcomes on the PDSS and psychosocial functioning (Sheehan Disability Scale). Compared with patients without HCA (N=154), patients with HCA (N=46) experienced significantly more severe symptoms of PD (d=0.60), agoraphobia (d=0.47), and comorbid depression (d=0.46); significantly worse psychosocial impairment (d=0.63) and anxiety sensitivity (d=0.75); greater personality disorder burden (d=0.45)-particularly with cluster C disorders (d=0.47)-and more severe interpersonal problems (d=0.54). HCA significantly moderated the likelihood of clinical response, predicting nonresponse to ART (B=-2.05, 95% CI=-4.17 to -0.30, OR=0.13, z=-2.14, p=0.032) but not CBT or PFPP. HCA did not interact with treatment condition to predict slopes of PDSS change. The results of this study highlight the importance of HCA in formulating treatment recommendations. Increased awareness of HCA's effects on severity of PD and treatment responsiveness among patients with PD may improve outcomes.

Exploring termination setback in a psychodynamic therapy for panic disorder.

Termination in psychodynamic therapy (PDT) is a potentially conflictual and turbulent phase for patients, with a risk for increases in symptoms. However, few studies of PDT have assessed symptoms frequently enough during the treatment to determine whether such setbacks are in fact common in PDT. In a doubly randomized clinical preference trial, 217 adults, female = 163; M age = 34.8 (12.6), with panic disorder with or without agoraphobia were treated with panic-focused psychodynamic psychotherapy (PFPP) or panic control treatment (PCT), a form of cognitive behavioral therapy. Participants completed the Panic Disorder Severity Scale Self-Report (PDSS-SR) weekly during treatment (Weeks 1-12), and 6, 12, and 24 months after treatment. Using piecewise latent growth curve modeling, we tested the trajectories of change focusing on the termination phase in PFPP. Week-to-week improvement on the PDSS-SR stopped (a termination setback [TS]) in PFPP during Weeks 10-12, whereas PCT participants continued to improve. Larger symptom reductions up to Week 10 in PFPP predicted a more severe TS. Less avoidant attachment and less severe interpersonal problems also predicted more severe TS. The TSs tended to last, as evidenced by inferior outcomes, up to the 12-month follow-up. This study provides evidence of a TS in PDT. Resurgence of symptoms as termination approached was more common in PFPP than in PCT. Studies involving weekly assessment of primary and comorbid symptoms, as well as qualitative analyses of the patient experiences of the therapeutic process during termination, in different forms of PDT, are warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Changing Embodied Dialogical Patterns in Metacognitive Interpersonal Therapy

According to proponents of Dialogical Self Theory (DST), the self is made up of a series of I-positions, which continuously interact, negotiating potential courses of action, and attributing meaning to events. Individuals with personality disorders tend to attribute meaning according to stereotyped dialogical relationship patterns which prevent them from achieving social adaptation and fulfillment. Of note, in our perspective, we do not necessarily take dialogical relationship as healthy. We refer to dialogical thinking as a form of thoughts about interpersonal interactions, but the very dialogue may itself be stuck and repetitive as in the case of patients with personality disorders (Dimaggio et al., 2003, 2010; Schacter et al., 2012). These patterns do not just take the form of verbal discourse, but are instead embodied and rooted within internalized processes; which are themselves laden with affect, behavioral dispositions and somatic experiences. Using a case study we demonstrate how Metacognitive Interpersonal Therapy (MIT) provides a platform for changing embodied dialogical patterns, via imagery and body work. These techniques enable revision of the embodied component of the dialogical pattern, promoting the emergence of new I-positions. These new patterns comprise more adaptive aspects and correspondingly impede the enactment of previous maladaptive coping strategies, that were driven by pathological I-positions. Finally, we discuss the implications of experiential work in this context, as a crucial component of dialogical oriented therapies for people experiencing severe interpersonal problems such as personality disorders.

CHANGING EMBODIED RELATIONAL PATTERNS IN METACOGNITIVE INTERPERSONAL THERAPY

Individuals with personality disorders tend to attribute meaning according to stereotyped relationship patterns which prevent them from achieving social adaptation and fulfilment. These mental patterns are more than mere cognitive representations of the self and others. They are embodied and laden with affect, behavioral dispositions, and somatic experiences. The main purpose of this work is to present how metacognitive interpersonal therapy provides a platform for changing embodied patterns, via imagery and sensorimotor work. As discussed, these techniques facilitate the revision of the embodied component of maladaptive patterns and promote the emergence of new and healthier patterns. These new patterns comprise more adaptive aspects and correspondingly impede the enactment of previous maladaptive coping strategies that were driven by pathological schemas. We note how experiential work is best performed in a context of constant regulation of the therapeutic relationship, in order to detect any possible relational impasses and ruptures, reflecting on them until they are repaired. We also show the use of techniques in the initial phase of therapy to allow a more dynamic and rich case formulation. Finally, we discuss the implications of how experiential work might be a crucial component in psychotherapy for persons experiencing severe interpersonal problems such as personality disorders

Emotional Facial Expression Recognition and Expressivity in Type I and Type II Alcohol Dependent Patients

Alcohol dependent patients (ADs) are known to encounter severe interpersonal problems. Nonverbal communication skills are important for the development of healthy relationships. The present study aimed to explore emotional facial expression (EFE) recognition and posed and spontaneous EFE expressivity in male ADs divided into two groups according to Cloninger’s typology and the impact of their interpersonal relationship quality on the potential nonverbal deficits. Twenty type I ADs, twenty-one type II ADs, and twenty control participants took part in an EFE recognition task and an EFE expressivity task that considered personal emotional events (spontaneous expressivity) and EFE in response to a photo or word cue (posed expressivity). Coding was based on judges’ ratings of participants’ emotional facial expressions. Participants additionally completed a questionnaire on interpersonal relationship quality. No difference between the three groups emerged in the EFE recognition task. Type II ADs showed heightened deficits compared with type I ADs in EFE expressivity: Judges perceived less accurate posed EFE in response to a cue word and less intense and positive spontaneous EFE in type II ADs compared to control participants. In addition, type II ADs reported more relationship difficulties compared to both type I ADs and control participants. These interpersonal relationship difficulties were related to some of the EFE expressivity deficits of AD-IIs. This study underlines the important differences between the interpersonal functioning of AD subtypes.

STRESS AT THE WORKPLACE DURING RESIDENCY TRAINING

Residency period during postgraduate training in medical profession is well known for physical and mental stress . There are many situational, professional, and personal sources of stress, which the author reviews: heavy work- load, sleep deprivation, difficult patients, poor learning environments, relocation issues, isolation and social problems, financial concerns, cultural issues, information overload, and career planning issues. Stress can also originate from gender-related issues and issues related to spouses and family members. The author also describes less commonly documented sources of stress ,which is observed in residents who perform marginally and in some cases should not have been passed on from medical school, or who are studying specialties not compatible with their skills and personalities, or who foster severe interpersonal problems on the job. Common effects of stress include frequent absenteeism ,minor health problems, anxiety, depression, obsessive compulsive trends, hostility, and alcohol and substance abuse. The author outlines essential elements of an assistance program, states how important such problems can be in saving both residents and their institutions needless difficulties and costs, and presents important issues for the consideration of all involved in residents' training. Purpose of this article is to provide an overview gathered from the extensive literature, of the various stressors resident face; and to discuss assistance to residents and make recommendations about the essential elements of an assistance program.

A single-case experimental demonstration of Functional Analytic Psychotherapy with two clients with severe interpersonal problems.

Functional Analytic Psychotherapy (FAP) is emerging as an effective psychotherapy for psychiatric clinical cases. However, there is little research demonstrating the process of change of FAP. The present study evaluated the introduction and withdrawal of FAP interventions on therapy-interfering verbal behaviors of two participants who were in therapy with the researcher. The single-case experimental design was A-B1-B2-C1-C2 (A= therapy without planned interventions; B1 and B2 = introduction of FAP, and C1 and C2 = FAP withdrawal) and occurred over 20 sessions for each client. Results demonstrated both intrasubject and intersubject

Interpersonal problems among 988 Norwegian psychiatric outpatients. A study of pretreatment self-reports

Objective No studies, to our knowledge, have examined what specific kinds of interpersonal problems characterize a general psychiatric outpatient population. Do they differ from the normal population in any specific way, apart from the expected “more of everything”? The aim of this study was to map and categorize a large psychiatric outpatient sample with regard to self-reported interpersonal problems. Method First-admission psychiatric patients completed the 64-item version of the Inventory of Interpersonal Problems (Horowitz et al, Inventory of Interpersonal Problems Manual. San Antonio, TX: The Psychological Corporation 2000) before treatment. Scores were compared with Norwegian reference data. Profile characteristics of 8 subgroups (octant groups), corresponding to 8 different forms of predominant interpersonal problem, were calculated according to the structural summary method (Gurtman and Balakrishnan, Circular measurement redux: the analysis and interpretation of interpersonal circle profiles. Clin Psychol Sci Pract. 1998;5[3]:344-360). Results The clinical sample had considerably more interpersonal problems than the normal reference sample. Among the 8 octant groups with different predominant interpersonal problems, the 3 most prevalent in the sample, characterized by a low degree of assertiveness (low agency), were also the most distressed with regard to interpersonal problems. Conclusions Psychiatric outpatients seem to have the most severe interpersonal problems along the agency dimension; that is, they have problems being assertive. Patients within different octant groups of the 64-item version of the Inventory of Interpersonal Problems system, corresponding to different kinds of specific, predominant interpersonal problems, have characteristic ways of relating to others, which ought to be identified and addressed in therapy.

Risk factors for suicide in Bali: a psychological autopsy study

BackgroundThe suicide rate in Bali has significantly increased in recent years. However, to date, there have been no case-control studies investigating risk factors for suicide.MethodsA psychological autopsy study was conducted comparing 60 suicide cases and 120 living controls matched in age, sex, and area of residence.ResultsMultiple logistic regression analysis identified the following risk factors for suicide: at least one diagnosis of axis-I mental disorder (OR: 14.84 CI: 6.12 - 35.94); low level of religious involvement (OR: 7.24 CI: 2.28 - 22.95); and severe interpersonal problems (OR: 3.86 CI: 1.36 - 11.01). Forty-eight (80.0%) of the suicide cases were diagnosed with mental disorders; however, only 16.7% visited a primary care health professional and none received psychiatric treatment during the 1 month prior to death.ConclusionClinical, religious, and psychosocial factors were associated with suicide. These results highlight the significance of early recognition and treatment of mental disorders, religious activities, and interpersonal problem-solving strategies for suicide prevention in Bali.

Transference Interpretations in Dynamic Psychotherapy: Do They Really Yield Sustained Effects?

Transference interpretation has remained a core ingredient in the psychodynamic tradition, despite limited empirical evidence for its effectiveness. In this study, the authors examined long-term effects of transference interpretations. This was a randomized controlled clinical trial, dismantling design, plus follow-up evaluations 1 year and 3 years after treatment termination. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were referred to the study therapists. Patients were randomly assigned to receive weekly sessions of dynamic psychotherapy for 1 year with or without transference interpretations. Five full sessions from each therapy were rated in order to document treatment fidelity. Outcome variables were the Psychodynamic Functioning Scales (clinician rated) and the Inventory of Interpersonal Problems (self-report). Rating on the Quality of Object Relations Scale (lifelong pattern) and presence of a personality disorder were postulated moderators of treatment effects. Change over time was assessed using linear mixed models. Despite an absence of differential treatment efficacy, both treatments demonstrated significant improvement during treatment and also after treatment termination. However, patients with a lifelong pattern of poor object relations profited more from 1 year of therapy with transference interpretations than from therapy without transference interpretations. This effect was sustained throughout the 4-year study period. The goal of transference interpretation is sustained improvement of the patient's relationships outside of therapy. Transference interpretation seems to be especially important for patients with long-standing, more severe interpersonal problems.

Transference Interpretation Is Active Treatment Component

Back to table of contents Previous article Next article Professional NewsFull AccessTransference Interpretation Is Active Treatment ComponentMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Apr 2008https://doi.org/10.1176/pn.43.7.0016Psychotherapy patients with a lifelong pattern of poor object relations profited more from one year of therapy with transference interpretations than from therapy without such interpretations.That was the finding from a unique, randomized, controlled clinical trial of psychotherapy for depression, anxiety, personality disorders, and interpersonal problems.“Our study identifies a core active treatment component, transference interpretation, with positive long-term impact on patient functioning, and thus represents an extension of previous research,” lead author Per Høglend, M.D., Ph.D., of the Department of Psychiatry at the University of Oslo, Norway, told Psychiatric News. “If our findings are replicated, they may have far-reaching implications for the education of psychotherapists and treatment of depression, anxiety, personality disorders, and chronic, more severe interpersonal problems.”In the study 100 outpatients seeking psychotherapy for depression, anxiety, personality disorders, or interpersonal problems were randomly assigned to receive weekly sessions of dynamic psychotherapy for one year with or without transference interpretations.For the transference group, therapists used the following techniques:Addressing transactions in the patient-therapist relationship.Encouraging exploration of thoughts and feelings about the therapy and therapist, including repercussions to the transference by high therapist activity.Encouraging patients to discuss how they believed the therapist might feel or think about them.Including the therapist explicitly in interpretive linking of conflicts, direct manifestations of transference, and allusions to the transference.Interpreting repetitive interpersonal patterns and linking these patterns to transactions between the patient and the therapist.In the comparison group, therapists explicitly avoided using these techniques.Outcome was measured by scores on the clinician-rated Psychodynamic Functioning Scales and the self-reported Inventory of Interpersonal Problems. Measurements were taken at baseline, mid-treatment, end of treatment, one-year follow-up, and three-year follow-up.The researchers hypothesized at the outset that a lifetime pattern of object relations—as determined by the presence of a personality disorder and scores on the Quality of Object Relations Scale (QOR)—would moderate the effects of treatment with patients having poorer object relations benefiting more.What they found was that both forms of psychotherapy—with and without transference interpretations—resulted in significant improvement during treatment and after termination. But in keeping with their hypothesis, the long-term effect of transference interpretations increased with lower scores on the QOR.This effect was sustained throughout the four-year study.Høglend told Psychiatric News that life events and additional treatment during the follow-up period were carefully recorded and probably do not account for the differences between the two treatment groups.“On the contrary, the comparison group had more additional treatment than the transference group,” he said. He added that the study is the first randomized, controlled trial designed to study long-term effects of transference interpretations.“The literature on transference is enormous—more than 8,000 articles and book chapters since Freud introduced the term in 1895,” he said. “But the empirical research on transference interpretation is sparse. None of the studies so far used an experimental design in which only one treatment component is experimentally manipulated. The associations reported in passive observational studies, nonexperimental studies, are open to several causal interpretations, rendering the research base inconclusive.”He added that future research will try to identify the mechanism that links transference interpretations to long-term improvement of interpersonal functioning.“Transference Interpretations in Dynamic Psychotherapy: Do They Really Yield Sustained Effects?” will be posted on AJP Advance on April 15 at<http://ajp.psychiatryonline.org/pap.dtl> and will be in the June print edition of AJP. ▪ ISSUES NewArchived

Predicting Psychotherapy Utilization for Patients With Borderline Personality Disorder

The purpose of this study was to create hypotheses that would serve as predicting variables in the planning of psychotherapeutic treatment for patients with borderline personality disorder (BPD). Twenty psychiatric inpatients were treated with psychoanalytically oriented psychotherapy for 6 weeks with the aim of clarifying, planning, and preparing them for outpatient psychotherapy. The authors investigated anxiety, aggression, interpersonal problems, and self-concept before and after inpatient treatment. Nine patients engaged in further outpatient psychotherapy. Significant predictors for engaging in further treatment were female gender, strong subjective perception of interpersonal problems, and generalized negative self-concept of own capacities. High reactive readiness for aggression and thorough conviction of self-efficacy had predictive value for nonengagement in further psychotherapy. Correlations between aggression and increased capability of one's self and severe interpersonal problems were found only in psychotherapy nonusers. Results emphasize the importance of acknowledging mechanisms of destruction, attachment, and mentalization in initial psychotherapy planning.

Abuse and Substance Abuse

Investigators have shown that a history of physical abuse, sexual abuse, or both is associated with more severe interpersonal problems and higher rates

Sources of stress for residents and recommendations for programs to assist them.

Bridging the gap between graduation from medical school and being board eligible in a medical specialty is a lengthy and arduous process. The fact that stress is typical during the residency training period is well-documented in the literature, as are its many situational, professional, and personal sources, which the author reviews: heavy work-load, sleep deprivation, difficult patients, poor learning environments, relocation issues, isolation and social problems, financial concerns, cultural and minority issues, information overload, and career planning issues. Stress can also stem from and exacerbate gender-related issues and problems for significant others, spouses, and family members. The author also describes less commonly documented sources of stress-often overlooked or postponed so long that stresses are inevitable for all concerned. These are associated with residents who perform marginally and in some cases should not have been passed on from medical school, or who are studying specialties not compatible with their skills and personalities, or who foster severe interpersonal problems on the job. Common effects of stress include anxiety, depression, obsessive-compulsive trends, hostility, and alcohol and substance abuse. To respond to the problems that these many stressors present to residents, the Accreditation Council for Graduate Medical Education (ACGME) requires that all post-medical-school medical training programs make assistance services available for all residents. The author outlines essential elements of an assistance program, states how important such problems can be in saving both residents and their institutions needless difficulties and costs, and presents important issues for the consideration of all involved in residents' training.