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Ridenour JM, Hamm JA, Wiesepape CN, Lysaker PH. Integrating Loss and Processing Grief in Psychotherapy of Psychosis. Psychiatry 2023; 86:173-186. [PMID: 36688824 DOI: 10.1080/00332747.2022.2161261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person's identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.
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Ridenour JM, Garrett M. Intent to Understand the Meaning of Psychotic Symptoms During Patient-Psychiatrist Interactions. Am J Psychother 2022:appipsychotherapy20220034. [DOI: 10.1176/appi.psychotherapy.20220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeremy M. Ridenour
- Erikson Institute for Education, Research, and Advocacy, Austen Riggs Center, Stockbridge, Massachusetts (Ridenour); Department of Clinical Psychiatry, State University of New York Downstate Medical Center, and Psychoanalytic Association of New York, New York City (Garrett)
| | - Michael Garrett
- Erikson Institute for Education, Research, and Advocacy, Austen Riggs Center, Stockbridge, Massachusetts (Ridenour); Department of Clinical Psychiatry, State University of New York Downstate Medical Center, and Psychoanalytic Association of New York, New York City (Garrett)
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Ridenour JM, Hamm JA, Neal DW, Hillis JD, Gagen EC, Zalzala AB, Lysaker PH. Navigating an Impasse in the Psychotherapy for Psychosis. J Contemp Psychother 2022. [DOI: 10.1007/s10879-022-09571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ridenour JM, Lewis KC, Siefert CJ, Stein MB. Longitudinal stability of Social Cognition and Object Relations Scale-Global Rating Method dimensional ratings, score ranges and narrative 'blandness' in a clinical sample. Clin Psychol Psychother 2022; 29:1447-1456. [PMID: 35212082 DOI: 10.1002/cpp.2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 11/07/2022]
Abstract
While understanding how internalized representations of others (i.e., object relations) change over the course of treatment is essential for treatment planning and evaluation of progress, few studies have examined the nature of these changes through repeated psychological assessments. In this study, we applied the SCORS-G to Thematic Apperception Test narratives for 61 adult patients with complex psychiatric problems undergoing residential treatment over an 18-month period. Over the course of treatment, patient representations of self and others became more complex, indicating improvements in mentalization. Further, an analysis of default ratings (i.e., an aspect of story 'blandness') suggested that certain shifts in SCORS-G dimensional scores over time were accounted for by greater degree of scorable content across time points, rather than changes specific to the dimensions themselves. Findings from novel exploratory analyses aimed at evaluating the test-retest reliability of both default rating proportion and several emerging alternative scoring approaches (including changes in minimum, maximum and range of scores on individual dimensions) are reported. While the magnitude of change across mean dimensional scores was found to be lower compared to those previously found in outpatient populations, our results suggest that the SCORS-G remains capable of detecting changes in mentalization capacities in individuals contending with longstanding, severe psychiatric impairment and personality-based psychopathology. Implications for treatment, assessment and future research are discussed.
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Affiliation(s)
- Jeremy M Ridenour
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, Massachusetts, USA
| | - Katie C Lewis
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, Massachusetts, USA
| | - Caleb J Siefert
- Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Michelle B Stein
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Mariotti EC, Waugh MH, McClain CM, Beevers LG, Clemence AJ, Lewis KC, Miller R, Mulay AL, Ridenour JM, Huprich SK, Pitman SR, Meehan KB. Assessing Self-Definition and Relatedness in Level of Personality Functioning. J Pers Disord 2021; 35:857-880. [PMID: 33764821 DOI: 10.1521/pedi_2021_35_516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The two polarities model (TPM) of personality organizes psychological assessment and psychotherapy and connects to personality disorder diagnosis using the DSM-5 Alternative Model for Personality Disorders (AMPD). The authors developed scales assessing the TPM from an existing self-report measure for level of personality functioning (LPF), a core component of the AMPD. Iterative content analyses of the LPF measure yielded scales for Autonomy and Communion corresponding to dimensions of the TPM. The scales were refined via internal consistency analyses using a measure of psychological attachment and studied in development and validation samples. Associations with relevant external criteria were explored in a series of multiple regressions. The new content-based LPF scales were illustrated with a case vignette. Although the new Autonomy/Communion scales await further validation prior to clinical use, initial evidence suggests that they may bridge the nomological nets of the TPM and AMPD and potentially offer clinical utility in assessment and treatment planning.
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Affiliation(s)
| | - Mark H Waugh
- University of Tennessee, Knoxville.,Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | | | | | | | | | - Racheli Miller
- Center for Compassion Focused Therapy, New York, New York
| | - Abby L Mulay
- Medical University of South Carolina, Charleston, South Carolina
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Ridenour JM, Knauss D, Neal DW. Promoting an integrating recovery style: A mentalization-informed approach. J Clin Psychol 2021; 77:1786-1797. [PMID: 34287877 DOI: 10.1002/jclp.23220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022]
Abstract
How a person recovers after a psychotic episode is known to be a key predictor of treatment response, impacting a person's sense of self and interpersonal relationships. An integrating recovery style, characterized by more curiosity about the psychotic episode and its potential meaning, has been shown to produce better outcomes. A novel therapeutic treatment, mentalization-based therapy for psychosis, targets the potential mechanisms (i.e., curiosity about mental states, affect modulation, and interpersonal awareness) that might foster an integrating recovery style, enabling a person to make meaning of their episode and use others to facilitate exploration. In this case study, we present the treatment of an emerging adult who sought residential treatment following her first psychotic episode and who initially presented with a guarded, dismissive approach to her symptoms and gradually formed a more integrating recovery style.
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Affiliation(s)
| | - Daniel Knauss
- Austen Riggs Center, Stockbridge, Massachusetts, USA
| | - David W Neal
- Austen Riggs Center, Stockbridge, Massachusetts, USA
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Ridenour JM, Lewis KC, Siefert CJ, Pitman SR, Knauss D, Stein MB. Card pull effects of the Thematic Apperception Test using the Social Cognition and Object Relations‐Global Rating Method on complex psychiatric sample. Clin Psychol Psychother 2021; 28:1079-1090. [DOI: 10.1002/cpp.2554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Jeremy M. Ridenour
- Erikson Institute for Education and Research Austen Riggs Center Stockbridge Massachusetts USA
| | - Katie C. Lewis
- Erikson Institute for Education and Research Austen Riggs Center Stockbridge Massachusetts USA
| | - Caleb J. Siefert
- Department of Behavioral Sciences University of Michigan‐Dearborn Dearborn Michigan USA
| | - Seth R. Pitman
- Erikson Institute for Education and Research Austen Riggs Center Stockbridge Massachusetts USA
| | - Daniel Knauss
- Erikson Institute for Education and Research Austen Riggs Center Stockbridge Massachusetts USA
| | - Michelle B. Stein
- Department of Psychiatry Massachusetts General Hospital/Harvard Medical School Boston Massachusetts USA
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Ridenour JM, Hamm JA, Neal DW, Lysaker PH. From Fragmentation to Coherence: Psychodynamic Psychotherapy for Psychosis through the Lens of Metacognition. Psychodyn Psychiatry 2020; 48:455-476. [PMID: 33779223 DOI: 10.1521/pdps.2020.48.4.455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Psychoanalysis has produced important theories that help explain the radical alterations in self-experience central for persons experiencing psychosis. These concepts have led to important clinical developments, case studies, and some research on the efficacy of psychodynamic psychotherapy for psychosis (Gottdiener, 2006). However, psychodynamic psychotherapy has struggled to produce operationalized constructs to measure how it enhances self-development and the therapeutic mechanisms of action that facilitate these changes. Outside of psychoanalysis, some researchers have focused on the construct of metacognition (i.e. thinking about thinking) and its relevance to understanding psychosis. Proponents of this paradigm have created an integrative, exploratory therapy (MERIT, Lysaker & Klion, 2017) that blends various therapeutic traditions that overlap with psychodynamic psychotherapy and mentalization (Ridenour, Knauss, & Hamm, 2019). In this paper, we will present a short-term intensive case study of psychodynamic psychotherapy with a young man experiencing psychosis in residential treatment and then analyze the therapy through the lens of metacognition to provide constructs that illustrate the ways that it promotes recovery and self-integration.
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Affiliation(s)
- Jeremy M Ridenour
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, MA
| | - Jay A Hamm
- Midtown Community Mental Health, Eskenazi Health, and College of Pharmacy, Purdue University, Indianapolis, IN
| | - David W Neal
- Midtown Community Mental Health, Eskenazi Health, and College of Pharmacy, Purdue University, Indianapolis, IN
| | - Paul H Lysaker
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, MA
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Lewis KC, Ridenour JM, Pitman S, Roche M. Evaluating Stable and Situational Expressions of Passive-Aggressive Personality Disorder: A Multimethod Experience Sampling Case Study. J Pers Assess 2020; 103:558-570. [PMID: 33006488 DOI: 10.1080/00223891.2020.1818572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Passive-aggressive (PA) personality traits have received increasing attention in the research literature and are known to interfere with treatment engagement and recovery. Theoretical disagreements about PA, combined with its omission from the DSM-5, have left open many questions regarding its dynamic structure and temporal stability. Our goal in the present case study was to use a multimethod, experience sampling assessment framework for a single research subject enrolled in long-term residential treatment who exhibited significant PA traits to provide a complex portrait of daily interpersonal behaviors and experiences across a range of contexts. We review data gathered over a year of residential treatment to identify changes in self and interpersonal functioning and to deepen our understanding of the dynamic motivational structure of PA over time. Our findings expand understanding of both PA dynamics and provide support for integrating multimethod assessment into routine clinical practice.
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Affiliation(s)
- Katie C Lewis
- Austen Riggs Center, Erikson Institute for Education and Research, Stockbridge, Massachusetts
| | - Jeremy M Ridenour
- Austen Riggs Center, Erikson Institute for Education and Research, Stockbridge, Massachusetts
| | - Seth Pitman
- Austen Riggs Center, Erikson Institute for Education and Research, Stockbridge, Massachusetts
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Waugh MH, McClain CM, Mariotti EC, Mulay AL, DeVore EN, Lenger KA, Russell AN, Florimbio AR, Lewis KC, Ridenour JM, Beevers LG. Comparative Content Analysis of Self-Report Scales for Level of Personality Functioning. J Pers Assess 2020; 103:161-173. [PMID: 31917602 DOI: 10.1080/00223891.2019.1705464] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Content validity analyses of eight self-report instruments for assessing severity of personality disorder (PD), also known as Level of Personality Functioning (LPF), were conducted using the conceptual scheme of the Alternative Model for Personality Disorders (AMPD; APA, 2013). The item contents of these eight inventories were characterized for the LPF constructs of Identity (ID), Self-Direction (SD), Empathy (EM), and Intimacy (IN) along with the pathological personality trait domains of Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism. Severity of pathology (SV) reflected in item content was also rated. Raters demonstrated robust agreement for AMPD and SV constructs across instruments. Similarity between instrument AMPD construct profiles was quantified by intraclass correlations (ICC). Results showed the instruments were generally similar in AMPD-construct coverage, but some important differences emerged. The subscales of the instruments also were characterized for the degree to which they reflect the four LPF (ID, SD, EM, IN) domain constructs. Collectively, these content validity comparisons clarify the equivalence of instruments for AMPD constructs and the relative proportions of construct coverage within instrument subscales. These results can inform future research with LPF self-report instruments and guide clinicians in selecting an LPF-related instrument for use in practice.
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Affiliation(s)
- Mark H Waugh
- Oak Ridge National Laboratory.,University of Tennessee, Knoxville
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Affiliation(s)
| | - Jay A. Hamm
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN, USA
| | - Meg Czaja
- Center for Motivation and Change, New Marlborough, MA, USA
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Abstract
The utilization of multimethod assessment approaches can provide comprehensive information regarding daily interpersonal and personality functioning, increasing opportunities to guide treatment planning in a more personalized, evidence-based manner. The routine implementation of multimethod assessment within clinical settings, however, remains rare, and there are few studies that have reviewed the clinical utility of multimethod assessment. Our goal in this study was to analyze multimethod data collected from a single research subject enrolled in residential treatment in order to illustrate the process of integrating data across both single-occasion (e.g., self-report, performance-based, and behavioral tests) and multitimepoint (ecological momentary assessment of interpersonal experiences) dimensions. Results revealed both areas of convergence and divergence across measures, enabling the development of a complex clinical formulation that sharpened diagnostic considerations and contributed valuable insights to treatment planning. Our findings provide support for the value of incorporating multimethod assessment into routine clinical practice.
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Mulay AL, Waugh MH, Fillauer JP, Bender DS, Bram A, Cain NM, Caligor E, Forbes MK, Goodrich LB, Kamphuis JH, Keeley JW, Krueger RF, Kurtz JE, Jacobsson P, Lewis KC, Rossi GMP, Ridenour JM, Roche M, Sellbom M, Sharp C, Skodol AE. Borderline personality disorder diagnosis in a new key. Borderline Personal Disord Emot Dysregul 2019; 6:18. [PMID: 31827801 PMCID: PMC6886204 DOI: 10.1186/s40479-019-0116-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). METHOD Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. RESULTS Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. CONCLUSIONS Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.
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Affiliation(s)
- Abby L Mulay
- 1Medical University of South Carolina, 29C Leinbach Drive, Charleston, SC 29407 USA
| | - Mark H Waugh
- 2Oak Ridge National Laboratory (ORNL) & University of Tennessee Knoxville, Knoxville, TN 37996 USA
| | | | - Donna S Bender
- 4Tulane University, 6823 St. Charles Ave., Bldg. 92, New Orleans, LA 70118 USA
| | | | - Nicole M Cain
- 6Rutgers University, Graduate School of Applied and Professional Psychology, 152 Frelinghuysen Rd, Piscataway, NJ 08854-8020 USA
| | - Eve Caligor
- 7Columbia University, 1501 Riverside Drive, New York, NY 10032 USA
| | - Miriam K Forbes
- 8Macquarie University, Balaclava Rd., Macquarie Park, NSW 2109 Australia
| | | | - Jan H Kamphuis
- 10University of Amsterdam (UvA), Nieuwe Achtergracht, 129B, 1001 NK Amsterdam, Netherlands
| | - Jared W Keeley
- 11Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA 23284-2018 USA
| | - Robert F Krueger
- 12University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455 USA
| | - John E Kurtz
- 13Villanova University, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Peter Jacobsson
- 14Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katie C Lewis
- 15Austen Riggs Center, 25 Main Street, P.O. Box 962, Stockbridge, MA 01262 USA
| | - Gina M P Rossi
- 16Department of Psychology, Personality and Psychopathology Research group Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jeremy M Ridenour
- 15Austen Riggs Center, 25 Main Street, P.O. Box 962, Stockbridge, MA 01262 USA
| | - Michael Roche
- 17Penn State Altoona, 3000 Ivyside Park, Altoona, PA 16601 USA
| | - Martin Sellbom
- 18University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Carla Sharp
- 19University of Houston, 3695 Cullen Boulevard Room 126, Houston, TX 77204-5022 USA
| | - Andrew E Skodol
- 20University of Arizona, 1501 N. Campbell Avenue, PO Box 245017, Tucson, AZ 85724 USA
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Abstract
Theoretical perspectives on personality and the development of psychopathology have shifted markedly over the last 7 decades. However, it remains unclear how those changes affect mental health practice. Comprehensive and conscientiously recorded reports of psychological testing provide a clear window on this process because they comprise distinctive records of how patients are assessed and understood. For this study, we conducted an exploratory, qualitative analysis of the narratives of the testing reports over the past 65 years at the Austen Riggs Center, a private psychiatric hospital and residential treatment center, to assess changes over time and to evaluate the influence that various factors had on the reports. The data revealed significant changes in psychologists' ways of assessing and conceptualizing personality and identity, adaptive functioning, and psychological development. Additionally, we evaluated how the evolving theoretical influences, such as institutional, professional, and sociohistorical factors affected the psychologist's model of psychopathology and development. This study raises important questions about how theoretical innovations affect clinical practice over time.
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