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The main aim of this study was to examine the relationship between therapists' emotional responses and patients' personality evaluated by 3 dimensional diagnostic approaches empirically derived from the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 1999b): Two of these rely on the 5-factor model (FFM) domains, that were assessed with different SWAP-200 FFM versions developed by Shedler and Westen (SW-FFM scales; 2004) and McCrae, Lockenhoff, and Costa (MLC-FFM scales; 2005); the third approach is based on a multifaceted model of personality syndromes (SWAP personality dimension scales; see Shedler & Westen, 2004). A national sample of psychiatrists and psychologists (N = 166) of various theoretical orientations completed the Therapist Response Questionnaire (TRQ; Zittel Conklin & Westen, 2003) to identify patterns of therapist response, and the SWAP-200 to assess personality regarding a patient currently in their care. The findings showed good levels of construct validity between the SW-FFM and MLC-FFM scales, with the exception of the Openness trait. Moreover, specific SW-FFM and MLC-FFM scales were significantly associated with distinct SWAP personality dimension scales according in a conceptually meaningful nomological network. Although there were significant, theoretically coherent, and systematic relationships between therapists' responses and patients' personality features, overall the contribution of the SW-FFM and MLC-FFM traits in predicting therapists' responses was less sizable than the SWAP personality dimensions. These results seem to confirm the diagnostic and therapeutic value of countertransference as an essential tool in understanding psychological traits/dimensions that underlie the patients' psychopathology, both from within and outside of the FFM. (PsycINFO Database Record

Personality assessment can be useful to better understand the complexity of transgender and transsexual people. In particular, the Shedler Westen Assessment Procedure-200 (SWAP-200) is a measure that provides an accurate dimensional evaluation of personality. When assessing gender non-conforming people, however, clinicians can encounter some difficulties in giving appropriate ratings to all the items. A brief guide to the use of SWAP-200 with transgender patients is provided, taking into account three areas of psychological functioning: identity, relationships and sexuality. The authors review, one by one, the SWAP-200 items related to these areas, and, relying on their clinical experience and on scientific literature on Gender Dysphoria, they propose recommendations for making personality diagnoses meaningful. This paper facilitates a better clinical understanding of transgender people, and help clinicians to be more knowledgeable in the assessment of this heterogeneous population.

Background. Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved in MOH development has been advanced but was poorly studied. The hypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings.Objectives. This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect.Methods. Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender.Results. MOH patients were predominantly women and older. They showed lower traits of the SWAP-200’s cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200’s cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients.Conclusion. Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drug-addicted and personality-disordered patients were found. Practitioners’ careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs.

We evaluate 11 Rorschach variables with potential for assessing grandiosity and narcissism. Seven of these variables were drawn from previous literature: Omnipotence, Idealization, Reflection, Personal Knowledge Justification, Exhibitionism, Magic, and Elevated Mood States; four were developed for this research: Expanded Personal Reference, Narcissistic Devaluation, Narcissistic Deflation, and Narcissistic Denial. Using Rorschach protocols from American normative adults and Italian adult outpatients, the dimensional structure of these variables was evaluated by principal components analysis, and validity was tested by correlations with clinician ratings of narcissism on two scales from the Shedler–Westen Assessment Procedure–200 that were made after at least five sessions with the primary clinician. A cohesive dimension was found in both data sets defined by Expanded Personal Reference, Personal Knowledge Justification, Omnipotence, and Idealization, and it was meaningfully correlated with the clinician ratings of narcissism ( M r = .41). Implications of the findings include the applicability of these variables in clinical practice and research for assessing narcissistic personality dynamics.

Measures of current behavior are rarely incorporated into risk assessment. Therefore, the current study used a behavior rating scale to assess prison officers' observations of inmates prison behavior and examined the contribution of these ratings for risk assessment. Prison officers rated 272 sexual and violent offenders in three different correctional treatment facilities in Berlin, Germany. Factor analysis revealed three psychologically meaningful factors measuring externalizing, internalizing and adaptive prison behavior. The construct validity of the three factors was established through correlational analyses with standardized risk assessment instruments. Externalizing and internalizing behaviors were significant predictors of violent recidivism after release. In addition, externalizing was a significant predictor of institutional misconduct, whereas adaptive and internalizing behavior predicted whether an inmate was granted privileges (e.g., minimum-security confinement). Logistic regression analyses indicated that externalizing behavior ratings added incrementally to the Level of Service Inventory-Revised for the prediction of institutional misconduct and violent recidivism. The results indicate that prison officers observe important prison behaviors and that behavioral ratings can improve risk assessment.

Narcissistic personality disorder (NPD) is one of the most challenging clinical syndromes to treat in psychotherapy, especially due to the difficulties of establishing a good enough therapist-patient relationship. Countertransference responses to NPD can be particularly intense, frustrating, and difficult to manage, as is often reported in the clinical literature though not clearly supported empirically. The aims of this study were to (a) investigate the relationship between patients' NPD and therapists' responses; (b) examine the associations between patient, clinician, therapy variables and clinicians' reactions during treatment of NPD patients; and (c) provide an empirically derived portrait of countertransference with NPD. A sample of psychiatrists and clinical psychologists (N = 67) completed the Therapist Response Questionnaire to identify patterns of countertransference, the Shedler-Westen Assessment Procedure-200, and the Global Assessment of Functioning Scale to assess the personality pathology and psychosocial functioning of a patient in their care. The results showed that NPD was positively associated with hostile/angry, criticized/devalued, helpless/inadequate, and disengaged countertransference and negatively associated with therapists' positive response, regardless of patients' personality and psychosocial functioning. NPD patients with stronger traits of cluster B personality pathology tended to elicit more negative and heterogeneous countertransference reactions than NPD patients without these features. The countertransference patterns with NPD patients were not strongly influenced by the variables of clinicians and therapy, with the exception of clinical experience. Overall, the portrait of therapists' reactions to NPD provided a clinically nuanced and empirically founded description strongly resembling theoretical-clinical accounts. The therapeutic implications of these findings were discussed. (PsycINFO Database Record

Mentalization, operationalized as reflective functioning (RF), can play a crucial role in the psychological mechanisms underlying personality functioning. This study aimed to: (a) study the association between RF, personality disorders (cluster level) and functioning; (b) investigate whether RF and personality functioning are influenced by (secure vs. insecure) attachment; and (c) explore the potential mediating effect of RF on the relationship between attachment and personality functioning. The Shedler-Westen Assessment Procedure (SWAP-200) was used to assess personality disorders and levels of psychological functioning in a clinical sample ( N = 88). Attachment and RF were evaluated with the Adult Attachment Interview (AAI) and Reflective Functioning Scale (RFS). Findings showed that RF had significant negative associations with cluster A and B personality disorders, and a significant positive association with psychological functioning. Moreover, levels of RF and personality functioning were influenced by attachment patterns. Finally, RF completely mediated the relationship between (secure/insecure) attachment and adaptive psychological features, and thus accounted for differences in overall personality functioning. Lack of mentalization seemed strongly associated with vulnerabilities in personality functioning, especially in patients with cluster A and B personality disorders. These findings provide support for the development of therapeutic interventions to improve patients’ RF.

The aim of this study was to examine the relationship between therapists' emotional responses and patients' personality disorders and level of psychological functioning.A random national sample of psychiatrists and clinical psychologists (N=203) completed the Therapist Response Questionnaire to identify patterns of therapists' emotional response, and the Shedler-Westen Assessment Procedure-200 to assess personality disorders and level of psychological functioning in a randomly selected patient currently in their care and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week).There were several significant relationships between therapists' responses and patients' personality pathology. Paranoid and antisocial personality disorders were associated with criticized/mistreated countertransference, and borderline personality disorder was related to helpless/inadequate, overwhelmed/disorganized, and special/overinvolved countertransference. Disengaged countertransference was associated with schizotypal and narcissistic personality disorders and negatively associated with dependent and histrionic personality disorders. Schizoid personality disorder was associated with helpless/inadequate responses. Positive countertransference was associated with avoidant personality disorder, which was also related to both parental/protective and special/overinvolved therapist responses. Obsessive-compulsive personality disorder was negatively associated with special/overinvolved therapist responses. In general, therapists' responses were characterized by stronger negative feelings when working with lower-functioning patients.Patients' specific personality pathologies are associated with consistent emotional responses, which suggests that clinicians can make diagnostic and therapeutic use of their responses to patients.

The aim of this study was to examine the stability of the factor structure and psychometric properties of the Therapist Response Questionnaire (Betan, Heim, Zittel Conklin, & Westen, 2005; Zittel Conklin & Westen, 2003), a clinician report instrument able to measure the clinician's emotional reactions to the patient in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 332) of psychodynamic and cognitive-behavioral orientation completed the Therapist Response Questionnaire, as well as the Shedler-Westen Assessment Procedure-200 (Westen & Shedler, 1999a, 1999b), to assess personality disorders and level of psychological functioning, regarding a patient currently in their care. They also administered the Symptom Checklist-90-Revised (Derogatis, 1994) to the patients. Exploratory and confirmatory factor analyses revealed 9 distinct countertransference factors that were similar to 8 dimensions identified in the original version of the measure: (a) helpless/inadequate, (b) overwhelmed/disorganized, (c) positive/satisfying, (d) hostile/angry, (e) criticized/devalued, (f) parental/protective, (g) special/overinvolved, (h) sexualized, and (i) disengaged. These scales showed excellent internal consistencies and good validity. They were especially able to capture the quality and intensity of emotional states that therapists experience while treating personality-disordered patients, as well as to better differentiate them; additionally, they tapped into the complexity of clinicians' reactions toward patients experiencing severe psychiatric symptomatology. Results seem to confirm that Therapist Response Questionnaire is a valid and reliable instrument that allows to evaluate patterns of countertransference responses in clinically sensitive and psychometrically robust ways, regardless of therapists' orientations. The clinical and research implications of these findings are addressed.

Patients with narcissistic personality disorder are among the most difficult to treat in therapy, especially for their strong resistance to treatment and several difficulties in establishing a therapeutic relationship characterized by intimacy, safety, and trust. In particular, therapists’ emotional responses to these patients can be particularly intense and frustrating, as reported in the clinical literature but rarely investigated empirically. The aims of this preliminary study were: 1) to examine the associations between patients’ narcissistic personality disorder and distinct therapists’ countertransference patterns; and 2) to verify whether these clinicians’ emotional reactions were influenced by their theoretical orientation (as well as gender and age). A national sample of psychiatrists and clinical psychologists (N = 250) completed the Therapist Response Questionnaire (TRQ) to identify patterns of therapist emotional response, and the Shedler-Westen Assessment Procedure-200 (SWAP-200) to assess personality disorder and level of psychological functioning in a patient currently in their care and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week). From the complete therapist sample, we identified a subgroup (N = 35) of patients with narcissistic personality disorder, and we found that this personality pathology was positively associated with criticized/mistreated and disengaged countertransference, but negatively associated with positive therapist response. Moreover, our results confirmed that the relationship between patients’ narcissistic personality disorder and therapists’ emotional responses was not dependent on clinicians’ theoretical approach (as well as their age and gender). These findings are consistent with clinical observations, as well as some empirical contributions, and have meaningful implications for clinical practice of patients suffering from this challenging pathology. Normal 0 14 false false false IT X-NONE X-NONE MicrosoftInternetExplorer4

Many studies document the efficacy of psychotherapy for acute syndromes such as depression, but less is known about personality change in patients treated for personality pathology. The Shedler-Westen Assessment Procedure (SWAP-200; Westen & Shedler, 1999a, 1999b) is an assessment tool that measures a broad spectrum of personality constructs and is designed to bridge the gap between the clinical and empirical traditions in personality assessment. In this article, we demonstrate the use of the SWAP-200 as a measure of change in a case study of a patient diagnosed with borderline personality disorder. We collected assessment data at the start of treatment and after 2 years of psychotherapy. The findings illustrate the personality processes targeted in intensive psychotherapy for borderline personality.

Countertransference can be viewed as a source of valuable diagnostic and therapeutic information and plays a crucial role in psychotherapy process and outcome. Some empirical researches have showed that patients' specific personality characteristics tend to evoke distinct patterns of emotional response in clinicians. However, to date there have been no studies examining the impact of patients' symptomatology on the association between their personality and therapists' responses. This research aimed to (a) investigate the relationship between patients' symptom severity and clinicians' emotional responses; and (b) explore the possible mediated effect of symptom severity on the relationship between patients' personality pathology and countertransference responses. A sample of psychiatrists and clinical psychologists (N = 198) of different theoretical orientations completed the Shedler-Westen Assessment Procedure-200 and the Therapist Response Questionnaire on a patient currently in their care, who then completed the Symptom Checklist-90-Revised. The findings showed that patients' symptomatology partially mediates the relationship between their specific personality disorders (in particular, schizotypal, borderline, histrionic, and avoidant) and therapists' emotional responses, but in general, the impact of symptom severity is less sizable than one aroused by patients' personality style. Higher levels of patients' symptom severity are most associated with an intense feeling of being overwhelmed, disorganization, helplessness, and frustration in clinicians. These countertransference reactions are not accounted for by therapists' different therapeutic approaches and other variables (as gender, age, profession, and experience). The clinical implications of these results are addressed.

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário A Personalidade é um dos objetos de estudo de maior relevância no campo das ciências sociais, que tem sido alvo de inúmeros estudos de investigação, dando origem a diferentes teorias sobre a sua estrutura, formação e funcionamento. O presente estudo pretende abordar de que forma a mudança na estrutura da personalidade versus mudança dos sintomas evoluem ao longo de um processo terapêutico. Neste sentido, a revisão de literatura incide sobre o conceito de personalidade e sua mudança, apresentando diferentes abordagens teóricas propostas por alguns autores, passando pela questão fundamental do próprio conceito de mudança em psicoterapia. Ao longo da exposição teórica, serão abordados alguns estudos que permitem entender de que forma a mudança da personalidade e dos sintomas ocorrem ao longo de um processo psicoterapêutico. A partir da literatura revista, conclui-se que essas mudanças são efetivamente mais notórias ao nível dos sintomas logo no início da terapia, comparativamente aos traços de personalidade que revelaram necessitar de um maior tempo de psicoterapia para que essa mudança ocorra. ABSTRACT: Personality is one of the objects of study most relevant in the social sciences, which has been the subject of numerous research studies, giving rise to different theories about its structure, formation, function. The present study aims to address how the changing structure of personality versus change of symptoms evolve over a therapeutic process. In this sense, the literature review focuses on the concept of personality and its change, presenting different theoretical approaches proposed by some authors, through the fundamental question of the concept of change in psychotherapy. Along the theoretical exposition, some studies that allow us to understand how the change of personality and symptoms occur along a psychotherapeutic process will be addressed. From the literature reviewed, it is concluded that these changes are actually more noticeable at the level of symptoms early in therapy, compared to personality traits revealed that require a longer psychotherapy for this change to occur. RESUMO: Problema: A perceção ao nível da mudança em psicoterapia de que os sintomas são os primeiros indicadores de mudança em relação aos traços de personalidade, tem vindo a ser apoiada pela literatura pesquisada. Contudo, não são muitos os estudos que relacionam estes dois conceitos. Objetivo: perceber, em contexto de psicoterapia analítica, a relação entre as mudanças na personalidade e o grau de sintomatologia apresentada em duas pacientes seguidas em psicoterapia, por diferentes terapeutas, por um período de 2 anos. Método: A personalidade foi avaliada através das gravações áudio de 4 sessões por cada período de avaliação: início, 6, 12, 18 e 24 meses com o Shedler-Westen Assessment Procedure (SWAP-200; Shedler & Westen, 1998). Os sintomas foram medidos através do Symptom Checklist-90- Revised (SCL-90-R; Derogatis & Savitz, 2000), em cinco e três momentos distintos na paciente 1 e paciente 2 respetivamente, ao longo do processo psicoterapêutico. Resultados: Concluiu-se que, tanto para a paciente 1 como para a paciente 2, a mudança sintomática deu-se mais rapidamente do que a mudança ao nível da personalidade. ABSTRACT: Problem: The perception at the level of changing in psychotherapy whose symptoms are the first indicators of changing in relation to personality traits, has been supported by literature. However, not many studies link these two concepts. Objective: To understand, in the context of analytic psychotherapy, the relationship between changes in personality and the degree of symptoms reported in two patients in psychotherapy followed by different therapists, for a period of 2 years. Method: Personality was assessed using the audio recordings of 4 sessions per each period: starting with 6, 12, 18 and 24 months with the Shedler-Westen Assessment Procedure (SWAP-200; Shedler & Westen, 1998). Symptoms were measured by the Symptom Checklist-90-Revised (SCL-90-R, Derogatis & Savitz, 2000), in five and three distinct moments in patient 1 and patient 2 respectively, during the psychotherapeutic process. Results: It was found that for both patient 1 and patient 2 the symptomatic change was faster than the change at the level of personality.

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário Problema: vários estudos têm correlacionado as mudanças na personalidade medida através do SWAP-200, com a evolução de outros aspetos do paciente, tais como mecanismos de defesa, sintomatologia, relação de objeto e capacidade de insight, ao longo do processo terapêutico. O cruzamento do SWAP-200 com o IIP-64 (Inventory of Interpersonal Problems) tem sido pouco investigado. Objetivo: comparar a evolução das variáveis personalidade e relações interpessoais ao longo de uma psicoterapia Método: aplicação do SWAP-200 e do IIP 64, a 2 pacientes em várias fases do seu processo terapêutico . Resultados: verifica-se, para a única paciente com evidente Perturbação de Personalidade, esta mostrou uma persistência no horizonte temporal abordado, enquanto que alguns dos problemas interpessoais com que se defrontava, registaram melhoria acentuada, embora já numa fase tardia do processo. ABSTRACT: Problem: Many studies have correlated the changes in personality measured by the SWAP-200, with the evolution of other aspects of the patient such as defense mechanisms, symptoms, object relations and insight capacity throughout the therapeutic process. The crossing of the SWAP-200 with the IIP-64 (Inventory of Interpersonal Problems) has been less investigated. Objective: To compare the development of personality variables and interpersonal relationships along a psychotherapy Method: using SWAP-200 and IIP 64, for 2 patients in diferent stages of their therapeutic process. Results: it was found, for single patient with obvious Personality Disorder, that it showed persistence, while some of the interpersonal problems she faced, showed marked improvement, but already late in the process.

Dissertação de Mestrado em Psicologia Clínica apresentada ao ISPA - Instituto Universtiário Nesta revisão de literatura pretende-se evidenciar o que se tem feito a nível da investigação dos métodos de avaliação das perturbações da personalidade, dando especial ênfase ao instrumento SWAP-200 como alternativa ao DSM-III. Começa-se com uma abordagem à personalidade. Segue-se uma descrição das perturbações da personalidade e critérios de avaliação segundo o DSM-IV-TR. Lista-se alguns dos instrumentos mais utilizados na avaliação das perturbações da personalidade, onde as informações são obtidas essencialmente através de auto-retratos, não refletindo os aspetos mais proeminentes do paciente. Finalmente apresenta-se o SWAP-200, como instrumento alternativo para nos proporcionar descrições clínicas detalhadas da personalidade, tanto de forma empírica, como quantitativamente, como expressão os seus autores Shedler e Westen, nas várias obras. ABSTRACT: This literature review aims to highlight what has been done in research methods for assessing personality disorders, with special emphasis on instrument SWAP-200 as an alternative to DSM-III. It starts with an approach to personality. The following is a description of personality disorders and evaluation criteria according to DSM-IV-TR. List out some of the most used tools in the assessment of personality disorders, where the information is obtained essentially through self-portraits, not reflecting the most prominent aspects of the patient. Finally we present the SWAP-200, as an alternative to provide us with detailed clinical descriptions of personality, both empirically and quantitatively, as an expression of perpetrators Shedler and Westen, in several works.

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário Na revisão de literatura, é abordada a forma como a definição de personalidade evoluiu até hoje, comparando os paradigmas da psicanálise, cognitivismo e o modelo dos traços do Big Five. Depois, são discutidos as condições e mecanismos da mudança de personalidade no contexto da psicoterapia. O objectivo do estudo de caso que se segue foi o de observar e avaliar as mudanças de traços de personalidade de uma paciente ao longo de um processo psicanalítico de 4 anos. Utilizando o Shedler-Westen Assessment Procedure (SWAP-200) em conjunto com as transcrições em discurso directo das sessões, foi estudado e comparado a personalidade no início, meio e fim da terapia. Verificou-se que o sujeito, começando a terapia com uma perturbação de personalidade, desenvolveu uma personalidade mais saudável no final da terapia. In the literature review, we aboard the manner in which the definition of personality has evolved until today, comparing the paradigms of psychoanalysis, cognitivism and the Big Five trait model. Afterwards, the conditions and mechanisms of personality change in the psychotherapeutic context are discussed. The goal of the following case study was to observe and evaluate the changes to a patients personality traits during a 4 year psychoanalytic process. Using the Shedler-Westen Assessment Procedure (SWAP-200) with the therapists direct speech transcripts, the subjects personality was studied and compared at the beginning, middle and end of the therapy. The subject, having begun therapy with a personality disorder, had developed a healthier personality at the end of the therapy