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Drew Westen

Publications and source records attributed to Drew Westen.

9 recordsLinked to original sources
PubMed2003

Quantifying construct validity: two simple measures.

Construct validity is one of the most central concepts in psychology. Researchers generally establish the construct validity of a measure by correlating it with a number of other measures and arguing from the pattern of correlations that the measure is associated with these variables in theoretically predictable ways. This article presents 2 simple metrics for quantifying construct validity that provide effect size estimates indicating the extent to which the observed pattem of correlations in a convergent-discriminant validity matrix matches the theoretically predicted pattern of correlations. Both measures, based on contrast analysis, provide simple estimates of validity that can be compared across studies, constructs, and measures meta-analytically, and can be implemented without the use of complex statistical procedures that may limit their accessibility.

Adolescent↗
PubMed2003

Personality diagnoses in adolescence: DSM-IV axis II diagnoses and an empirically derived alternative.

OBJECTIVE: The study of personality pathology in adolescence is in its infancy. This article examined the applicability and limits of DSM-IV axis II personality disorder diagnoses in adolescents, assessed the validity of a method for assessing adolescent personality pathology, and began to develop an empirically grounded classification. METHOD: A total of 296 randomly selected clinicians described a patient age 14-18 in treatment for maladaptive personality patterns using axis II ratings scales and the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A), a Q-sort instrument for assessing adolescent personality pathology. After examining the nature and frequency of axis II disorders in the sample, the authors used Q-factor analysis to identify naturally occurring groupings of patients on the basis of shared personality features. RESULTS: Axis II diagnoses in adolescents resembled those in adults, although application of DSM-IV criteria appeared to overdiagnose antisocial and avoidant personality disorder in adolescents. Q analysis with the SWAP-200-A isolated five personality disorders (antisocial-psychopathic, emotionally dysregulated, avoidant-constricted, narcissistic, and histrionic) and one personality style. Patients' dimensional scores on each diagnostic prototype showed predictable associations with ratings of current axis II disorders, measures of adaptive functioning, and symptoms assessed with the Child Behavior Checklist. CONCLUSIONS: With some exceptions, personality pathology in adolescence resembles that in adults and is diagnosable in adolescents ages 14-18. Categories and criteria developed for adults may not be the optimal way of diagnosing adolescents. Data from samples of adolescents may prove useful in developing an empirically and clinically grounded classification of personality pathology in adolescents.

Adolescent↗
PubMed2003

The external validity of controlled clinical trials of psychotherapy for depression and anxiety: a naturalistic study.

Psychotherapy researchers have increasingly called for clinical practice and training to focus on empirically supported therapies tested in randomized controlled clinical trials (RCTs). In this paper, we report data from a naturalistic study of successful treatments in clinical practice that bear on the external validity of ESTs for three disorders. Participants were 242 experienced doctoral-level clinicians who reported on their last successfully treated patient seeking treatment for clinically significant depression, panic, or anxiety without panic. Successful treatments typically take substantially longer than the 8-16 sessions characteristic of efficacy trials for these disorders, even for the briefest treatments (cognitive-behavioural). Of particular relevance for generalizability from RCTs, most patients in clinical practice present with multiple problems other than a single Axis I disorder, which clinicians of all theoretical orientations recognize and treat, and these co-occurring conditions have a substantial impact on treatment length in everyday practice. The data suggest the importance of effectiveness research in bridging research and practice. They also point to the utility of distinguishing two complementary ways in which effectiveness research can be understood and implemented: by starting with efficacy trials and then testing treatments with promising results in the laboratory using broader community samples; or by starting with everyday clinical practice, examining patterns of covariation between specific interventions and outcomes at clinically meaningful follow-up intervals with diverse and ecologically valid samples and using these data to generate prototypes of treatments that can be used to guide the next generation of experimental studies.

Anxiety Disorders↗
PubMed2003

Rethinking therapeutic action.

Like other core psychoanalytic constructs, the theory of therapeutic action is currently in flux, as theorists of differing persuasions propose different mechanisms. In this article, the authors attempt to integrate developments within and without psychoanalysis to provide a working model of the multifaceted processes involved in producing change in psychoanalysis and psychoanalytic psychotherapy. A theory of therapeutic action must describe both what changes (the aims of treatment) and what strategies are likely to be useful in facilitating those changes (technique). The authors believe that single-mechanism theories of therapeutic action, no matter how complex, are unlikely to prove useful at this point because of the variety of targets of change and the variety of methods useful in effecting change in those targets (such as techniques aimed at altering different kinds of conscious and unconscious processes). Interventions that facilitate change may be classified into one of three categories: those that foster insight, those that make use of various mutative aspects of the treatment relationship and a variety of secondary strategies that can be of tremendous importance. They propose that, in all forms of psychoanalytic treatment, we would be more accurate to speak of the therapeutic actions, rather than action.

Affect↗
PubMed2002

Relationship between attachment patterns and personality pathology in adolescents.

OBJECTIVE: To explore the relationship between attachment status and personality pathology in a large clinical sample of adolescents. METHOD: Two hundred ninety-four randomly selected psychiatrists and psychologists were each asked to provide data on a patient (aged 14-18 years) in treatment for maladaptive personality patterns. Clinicians completed several measures including a clinician-report attachment questionnaire, several measures of personality pathology, and a clinician-report version of the Child Behavior Checklist. RESULTS: In both dimensional and categorical analyses, secure attachment was negatively correlated with personality pathology and positively correlated with healthy functioning, whereas disorganized/unresolved attachment was strongly associated with multiple forms of personality pathology. Anxious/ambivalent attachment tended to be associated with measures of withdrawal, internalization, and introversion. Avoidant attachment style was not associated with any single form of personality pathology. CONCLUSION: The marked association between unresolved attachment and more severe psychopathology in adolescents, the lack of construct validity of avoidant personality disorder in adolescents, and the broader relations among attachment, personality, and psychopathology are discussed.

Adolescent↗
PubMed2002

Developments in cognitive neuroscience: I. Conflict, compromise, and connectionism.

The strength of psychoanalysis has always been its understanding of affect and motivation. Contemporary developments in cognitive neuroscience offer possibilities of integrating sophisticated, experimentally informed models of thought and memory with an understanding of dynamically and clinically meaningful processes. Aspects of contemporary theory and research in cognitive neuroscience are integrated with psychoanalytic theory and technique, particularly theories of conflict and compromise. After a description of evolving models of the mind in cognitive neuroscience, several issues relevant to psychoanalytic theory and practice are addressed. These include the nature of representations, the interaction of cognition and affect, and the mechanisms by which the mind unconsciously forges compromise solutions that best fit multiple cognitive and affective-motivational constraints.

Affect↗
PubMed2002

Developments in cognitive neuroscience: II. Implications for theories of transference.

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.

Adult↗
PubMedDate not supplied

A multidimensional meta-analysis of pharmacotherapy for bulimia nervosa: summarizing the range of outcomes in controlled clinical trials.

The empirical literature on pharmacotherapy for bulimia nervosa reveals mixed results. We examined the results of controlled clinical trials of pharmacotherapies for bulimia published from 1980 to 1999. To do this, we employed a multidimensional meta-analysis, a method for aggregating a range of clinically meaningful indicators of outcome (including but not limited to effect-size estimates) across studies. We found that pharmacotherapy for bulimia yields a moderate initial effect. However, only a small minority of patients recover, and the average patient continues to meet full DSM-IV criteria for the disorder. Combined pharmacotherapy and short-term psychotherapy appears to produce better results, although most patients continue to show symptoms at termination, and few data are available on sustained recovery over time. In accordance with recent calls in the medical literature for standardization of reporting practices in clinical trials, we suggest that investigators and meta-analysts report a range of indices that bear on efficacy and generalizability to clinical practice. These include exclusion rates and reasons for exclusion, percentage recovered, percentage improved, percentage remaining improved or recovered at follow-up, and percentage seeking additional treatment at follow-up, as well as outcome data for both completer and intent-to-treat samples.

Adult↗