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Biomedical subjects

E Marziali

Publications and source records attributed to E Marziali.

16 recordsLinked to original sources
PubMed1999

The Objective Behavioral Index: a measure for assessing treatment response of patients with severe personality disorders.

A measure that captures the frequency and intensity of experienced dysfunctional behaviors as well as the use of mental health services was developed and tested as part of a treatment controlled trial of patients with borderline personality disorder. The Objective Behavioral Index (OBI) was completed by 136 subjects with the diagnosis of borderline personality disorder before random assignment to treatment and by 35 subjects at each follow-up point. With one exception, the OBI subindexes (Dysfunctional Behaviors and Service Utilization) were not intercorrelated nor were they associated with any of the other patient status measures. Both of the OBI subindexes were sensitive to change after a course of psychotherapy. The OBI measurement system is easy to use and provides important information about behavioral dysfunction and service utilization. Also, contrary to expectations, service utilization is not associated with patient symptomatic and behavioral status.

Adaptation, Psychological↗
PubMed1999

Response to sexual assault: a relational perspective.

It has been suggested that although the severity of the stressor is the primary determinant of acute posttraumatic stress disorder (PTSD) symptoms, pre-existing personality patterns may be the primary contributors to the development of chronic PTSD symptomatology. The authors postulate that of the multiple personality factors that influence behavior and response to traumatic events, relational capacity or the ability to sustain interpersonal relationships provides an overarching construct for understanding the contribution of social contextual factors to post-trauma response. The results of this exploratory study support the authors' hypothesis that relational capacity is a significant factor in explaining persistent PTSD symptoms in a sample of adult women who have been raped. Significant correlations were found between measures of relational capacity, the Bell Object Relations Inventory and the Inventory of Interpersonal Problems and measures of distress, the Posttraumatic Symptom Scale, and the Beck Depression Inventory.

Adaptation, Psychological↗
PubMed1997

The contribution of group cohesion and group alliance to the outcome of group psychotherapy.

The contribution to outcome of two group-process factors, group cohesion and group therapeutic alliance, was tested in the context of a randomized, controlled treatment trial for borderline personality disorder. Group members from four time-limited groups of an experimental model of group psychotherapy completed measures of group cohesion and group alliance at prespecified intervals across the 30-session therapy. Outcome was measured in terms of psychiatric symptoms, social adaptation, and indicators of behavioral dysfunction. The results showed that cohesion and alliance were correlated significantly and separately contributed to outcome on most of the dependent measures. Stepwise regression analyses showed, however, that when compared with cohesion, alliance accounted for more outcome variance on the dependent measures. The clinical implications of the findings and the limitations of the study are discussed.

Adult↗
PubMed1997

Emotion processing in borderline personality disorders.

The aim of this study was to examine the ways in which adults with borderline personality disorder (BPD) experience and manage their feelings. Responses of 30 subjects who met the criteria for BPD on the Structured Clinical Interview for DSM-III-R were compared with 40 non-BPD controls on the following measures of emotion processing and affect regulation: 1) level of emotional awareness, 2) capacity to coordinate mixed valence feelings, 3) accuracy at identifying facial expressions of emotion, and 4) intensity of response to negative emotions. The results showed significant differences between the two groups on all measures. The borderlines showed significantly lower levels of emotional awareness, less capacity to coordinate mixed valence feelings, lower accuracy at recognizing facial expressions of emotion, and more intense responses to negative emotions than the nonborderline controls. The findings corroborate clinical observations of borderline patients' difficulties in regulating emotions. The implications of the results for the therapeutic management of BPD patients are discussed.

Adaptation, Psychological↗
PubMed1994

Severity as a diagnostic dimension of borderline personality disorder.

The purpose of this study was to identify diagnostic and severity subgroups within a cohort of patients with borderline personality disorder (BPD). Of 171 patients clinically diagnosed with BPD, 132 were Diagnostic Interview for Borderlines (DIB) positive. Through a process of random selection, 41 of the DIB positive subjects were also interviewed with the revised version of the DIB (DIBR) and approximately one half with two semi-structured research interviews, the Schedule for Affective Disorders (SADS) and the Personality Disorder Examination (PDE). All subjects completed four self-report measures of problematic behaviours, symptoms and social adaptation. The analyses included examination of: 1. the correspondence of the BPD diagnosis across the DIB, the DIBR and the PDE; 2. the association between DIBR scoring levels and scores on measures of symptoms and behavioural status; and 3. the co-occurrence of BPD with Axis I and other Axis II disorders. Correlations and analyses of variance between both the DIB and DIBR scoring levels and the scores on the four symptom and behavioural measures showed that the scoring levels (DIB 7 to 10; DIBR 8 to 10) could be used to distinguish three subgroups of BPD. The three groups differed in terms of concordance for BPD with the PDE and in terms of patterns of overlap with DSM-III-R, Axis I and other Axis II disorders. This study shows that BPD subgroups can be located on a continuum of symptomatic and behavioural severity and that each subgroup has a specific pattern of overlap with Axis I and other Axis II disorders.

Adolescent↗
PubMed1993

The assessment of ego development in borderline personality disorders.

The purpose of the study was to assess levels of ego functioning in a cohort of patients who met the criteria for borderline personality disorder. The Sentence Completion Test (SCT) and the Descriptions of Significant Others (DSO) test were used to measure dimensions of ego maturity. The borderline patients' responses on the SCT were compared with the responses of an outpatient sample of psychiatric patients and with general population norms established for the test. The scores on the SCT for a selected subgroup of five subjects were compared with their scores on the DSO. Contrary to expectation, the responses on the SCT by those with borderline personality disorder did not differ from those for the psychiatric outpatient sample or the general population norms. However the within-group comparisons between the SCT and the DSO for the subgroup of five subjects showed comparable trends between tests. Discussion of the results focuses on the interpretations of the borderline patients' responses to the two tests. Emphasis is placed on the need to distinguish subsets of ego functions, which can be assessed separately using a variety of measurement strategies.

Adolescent↗
PubMed1991

The power of the therapeutic relationship.

A review of the psychotherapy research literature of the last decade shows that considerable advances of clinical significance have been made toward defining and measuring components of the treatment relationship. The relevance of the therapeutic alliance for predicting outcome in diverse models of treatment is emphasized, and the implications of the findings for clinical training, practice, and research are discussed.

Adaptation, Psychological↗
PubMed1991

Group and family treatments for borderline personality disorder.

The authors review clinical and empirical studies on the effectiveness of group treatments and family-marital treatments for borderline patients. These studies support the use of the group format in treating borderline patients, but no empirical study has examined whether group treatment combined or sequenced with individual treatment, or individual treatment alone, is better than group treatment alone. Empirical studies of family interventions with borderline patients are lacking, but further research is warranted, since many studies have shown that family pathology, especially physical and sexual abuse, is related to the development of borderline pathology.

Adolescent↗
PubMed1990

Object representations in descriptions of significant others: a methodological study.

The aim of this methodological study was to extend Blatt, Wein, Chevron, and Quinlan's (1979) coding system for assessing levels of mental representations of others. Blatt devised a system for scoring spontaneous descriptions of parental figures on a scale that spanned five levels of object differentiation. A single level score was assigned. In this study a procedure was developed to generate scores for each of five representational levels, for two object descriptions, for each subject. The new procedure was based on the assumption that in each individual, all levels of differentiation are maintained albeit in varying proportions. The new coding method was tested in a contrast study in which the responses of a cohort of borderline patients were compared with those of a cohort of nonpsychiatric subjects. As predicted, all subjects were assigned scores at all five representational levels; however, the borderlines had a higher proportion of content units in the lower, least differentiated levels of object representation, and the nonpsychiatric subjects had higher scores at the more differentiated, conceptually complex levels. Results of the psychometric properties of the coding method are discussed. Work in progress to refine the method is outlined.

Adult↗
PubMed1988

Time-limited, group psychotherapy for borderline patients.

Preparation for treatment, group process and time boundaries are presented as components of a treatment model designed to respond to specific problems inherent in the nature of borderline personality disorder. A pilot study of the proposed treatment model is underway and one case illustration from this study is described to illustrate the adaptation to this treatment of a borderline patient with an extensive prior history of individual treatment.

Adaptation, Psychological↗
PubMed1984

Three viewpoints on the therapeutic alliance. Similarities, differences, and associations with psychotherapy outcome.

This study tested three systems for measuring patient and therapist contributions to the therapeutic relationship. Scales with parallel dimensions were used by patients, therapists, and clinician judges to rate the same therapy hours. The sample consisted of 42 patients selected on specific criteria for their suitability for brief psychotherapy (20 sessions). They were treated by experienced psychodynamic therapists and therapeutic change was assessed by six outcome measures. Similarities and differences between the three perspectives of the alliance and their association with outcome were examined. There were significant correlations between patients', therapists', and nonparticipant judges' ratings of the patients' positive and negative contributions and the therapists' positive contributions, but no agreement between the three perspectives in their estimates of therapists' negative contributions. Within each measurement system, patients' and therapists' positive contributions to the relationship were the best predictors of outcome. In conclusion, the results suggest that the patients' and therapists' ratings of the treatment relationship, although influenced by subjective bias, agree to some extent with the nonparticipant judges' ratings and are more powerful in predicting the outcome of psychotherapy.

Adult↗
PubMed1984

Analysis of emotional status during the hospital treatment of a borderline patient.

This single case study illustrates a methodology for identifying recurrent pathological emotional states in a hospitalized, borderline patient. Parallel therapeutic inputs are delineated and examined in terms of patient-specific responses. The results indicate that ratings of nursing notes recorded across three periods of hospitalization can reliably isolate the patient's most salient and debilitating emotional states. State-specific therapeutic interventions are extracted and their effectiveness noted. The analyses illustrate clinical phenomena which are congruent with what is known about borderline symptomatology. In addition, the study locates therapeutic errors which often occur when working with difficult patients.

Adult↗
PubMed1982

Psychotherapy practice and research: the interface.

The study of the psychotherapeutic process presents special problems to clinicians and clinician investigators. In the absence of supportive, working relationships between the therapist, patient and investigator, important data about therapeutic transactions cannot be obtained. In addition, we are lacking methodologies for isolating the significant therapeutic factors which explain variations in the outcome of psychotherapy. These problems need to be jointly addressed by clinicians and investigators if we are to advance the theory and practice of psychotherapy.

Humans↗
PubMed1981

Therapeutic alliance scales: development and relationship to psychotherapy outcome.

The authors describe the development of patient and therapist alliance scales and their application to the therapies of selected patients with good and poor outcomes following brief psychodynamic psychotherapy. They focus on therapist and patient contributions to the attitudinal-affective climate of the therapy rather than on specific therapist techniques. The findings support the value of separating the contributions to the therapeutic alliance made individually by the therapist and the patient. Only the patient's contribution to the therapeutic alliance was predictive of outcome. Patients who developed and maintained positive attitudes toward the therapist and the work of therapy achieved the greatest gains.

Adult↗