Biomedical subjects

Mark J Hilsenroth

Publications and source records attributed to Mark J Hilsenroth.

18 recordsLinked to original sources

PubMed2005

Clinical utility of the Defensive Functioning Scale in the assessment of depression.

The Defensive Functioning Scale (DFS) and Overall Defensive Functioning score (ODF) have been used as reliable and valid measures of defense structure when applied to clinical narratives. This study aims to replicate and extend positive clinical validity data for the ODF in the assessment of depression and examine the relationship between specific defense levels of the DFS and depressive symptoms. Sixty-nine outpatients who completed the Symptom Checklist 90-Revised and Personality Assessment Inventory were rated on the DFS by trained clinicians. Lower (more maladaptive) scores on the ODF were significantly related to the presence and severity of patient-reported depression symptoms. Furthermore, depression symptoms were significantly related to both the presence of low-level action defenses and an absence of higher-range defenses in the mental inhibitions-obsessional level. Findings from this study provide further support for the clinical application and relevance of the DFS system; support the theory of defensive processes falling into a hierarchy of adaptive functioning; and, because of a naturalistic setting, are highly generalizable to real-world practice.

Adult↗

PubMed2005

Childhood sexual abuse and adult defensive functioning.

Differences in defensive functioning between those who reported a history of childhood sexual abuse (CSA) and those who did not was examined in a naturalistic treatment-seeking sample of adult outpatients (N = 67). Defensive functioning and childhood sexual abuse history were rated by clinicians and external raters utilizing the DSM-IV Defensive Functioning Scale and the Abuse Dimensions Inventory, respectively, based on information gathered as part of a larger therapeutic assessment. Individuals reporting a history of CSA were found to use more major image-distorting level defenses than the non-CSA group, and abuse severity was also related to greater use of major image-distorting level defenses. Those reporting a history of CSA relied more on defenses indicative of impairment in realistic perception of self and others. This defensive style likely contributes to the greater difficulties in interpersonal functioning and psychological problems in adulthood.

Adaptation, Psychological↗

PubMed2005

The capacity for dynamic process scale (CDPS) and patient engagement in opiate addiction treatment.

This study examined the relationship between continuation in an opiate treatment program and patient characteristics such as affect regulation, insight, and capacity for interpersonal relations. Participants consisted of 63 patients randomly selected from those completing an initial interview at a short-term heroin detoxification program. Patient characteristics were assessed using the Capacity for Dynamic Process Scale (CDPS). Results of this study indicated that the CDPS total score for each patient was related to the subsequent number of treatment sessions attended by that patient and significantly differentiated dropouts from completers. These findings support previous use of the CDPS in psychotherapy research. In addition, this study extends use of the CDPS to research on brief pharmacotherapy treatment of opiate addiction.

Adult↗

PubMed2005

Reliability and validity of the Social Cognition and Object Relations Scale (SCORS) in the assessment of dream narratives.

In this study, we aimed to investigate the application of an externally rated measure of interpersonal representations (Social Cognition and Object Relations Scale [SCORS]; Westen, 1995) to dream narratives. A total of 80 student participants enrolled at a private university in the New York City metropolitan area completed a Dream Log and affect adjective checklist (Wellman, 2002) based on a recalled dream at both 1 month and 3 months following the September 11, 2001, terrorist attacks. Using the dreams provided in this study we examined the interrater reliability of SCORS ratings, the relationship of SCORS variables to an independently rated measure of dream distortion, and the relationship of SCORS variables to participants' own ratings of dream affect. Results indicated that dreams were reliably rated using the SCORS, 3 cognitive SCORS variables were significantly related to dream distortion, and affective SCORS variables were meaningfully related to participants' own ratings of affect in their dreams. Findings from this study provide support for the application of SCORS ratings to dream narratives. We discuss implications for further research and clinical application.

Cognition↗

PubMed2004

Multimethod Validity Assessment of the SWAP-200 Dysphoric Q-Factor.

The aim of this study was to investigate the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort Dysphoric Q-Factor with scales from the therapist, the patient, and independent observers. Therapists used the Shedler-Westen Assessment Procedure Q-Sort to describe their patients after the therapeutic assessment and the first two therapy sessions (when available). Independent observers completed a number of symptom distress, global functioning, and Axis II psychopathology measures after watching videotapes of the therapeutic assessment. They also completed a measure of social cognition and object relations after watching videotape of the therapeutic assessment and the first two therapy sessions (when available). Patients completed measures of symptomatology and personality assessment. Results indicated several significant correlations between the Dysphoric Q-Factor and a number of the clinician ratings of depressive symptomatology. In addition, three clinician ratings (Personality Disorder Index, Global Assessment of Functioning scale, and the experience and management of aggressive impulses variable of the Social Cognition and Object Relations Scale) demonstrated unique and nonredundant predictive ability in accounting for the variance of the Dysphoric Q-Factor. The patient self-report measures, however, did not correlate significantly with the Dysphoric Q-Factor, although several correlations demonstrated trends toward statistical significance.

Adult↗

PubMed2004

A consideration of challenges to psychological assessment instruments used in forensic settings: Rorschach as exemplar.

In this brief primer, we provide an outline of key issues that will help psychologists organize and prepare their expert testimony. These issues include the need to obtain essential sources of research, a review of the actual legal standards regarding admissibility of test data in expert testimony, the nature of the expert relative to the assessment instrument in expert testimony, the nature of legal versus scientific debate, and the examination of appropriate qualifications of expertise when offering legal testimony. In addition, we use a summary of information contained in several recent articles to address challenges directed against forensic psychological testing. We use the empirical literature on the Rorschach as an exemplar in discussing these issues, as the admissibility of the Rorschach in particular has been challenged, and the issues frequently focused on with the Rorschach are equally applicable to other psychological measures. In this article, we provide essential sources of Rorschach research regarding several empirical studies that summarize important information and directly address previous criticisms of the measure.

Expert Testimony↗

PubMed2004

The development of therapeutic alliance during psychological assessment: patient and therapist perspectives across treatment.

We examined the impact of patient- and therapist-rated alliance developed during psychological assessment on the subsequent alliance measured early and late in formal psychotherapy. We hypothesized that a working alliance developed during psychological assessment conducted from a collaborative therapeutic model of assessment (TMA; Finn & Tonsager, 1992, 1997; Fischer, 1994) between the patient and therapist would carry into formal psychotherapy. We also hypothesized that alliance for those patients receiving a TMA would be significantly greater than patients receiving psychological testing as usual. To test this hypothesis, we administered the Combined Alliance Short Form-Patient Version (Hatcher & Barends, 1996) and the Combined Alliance Short Form-Therapist Version (Hatcher, 1999) to a sample of outpatients and their therapists at the end of the assessment feedback session, early, and late in psychotherapy. The hypotheses were supported as alliance scales rated at the assessment feedback session demonstrated positive and significant relationships with alliance throughout formal psychotherapy and in relation to a control group. The clinical utility and research implications of these findings are discussed.

Adult↗

PubMed2004

A review of interpersonal-psychodynamic group psychotherapy outcomes for adult survivors of childhood sexual abuse.

This article discusses the use of interpersonal-psychodynamic group treatments for survivors of childhood sexual abuse. Empirically based interpersonal-psychodynamic group outcome studies are reviewed according to efficacy and effectiveness models of treatment outcome research. To facilitate the evaluation and comparison of clinically significant change across studies, effect size indicators were calculated when descriptive data were reported. Findings suggest that interpersonal-psychodynamic group therapy is an effective treatment approach for many survivors of childhood sexual abuse. Implications for future research are considered.

Adult↗

PubMed2003

A review of therapist characteristics and techniques positively impacting the therapeutic alliance.

The present review is a comprehensive examination of the therapist's personal attributes and in-session activities that positively influence the therapeutic alliance from a broad range of psychotherapy perspectives. Therapist's personal attributes such as being flexible, honest, respectful, trustworthy, confident, warm, interested, and open were found to contribute positively to the alliance. Therapist techniques such as exploration, reflection, noting past therapy success, accurate interpretation, facilitating the expression of affect, and attending to the patient's experience were also found to contribute positively to the alliance. This review reveals how these therapist personal qualities and techniques have a positive influence on the identification or repair of ruptures in the alliance.

Humans↗

PubMed2003

Short-term psychodynamic psychotherapy for depression: an examination of statistical, clinically significant, and technique-specific change.

This study investigates the effectiveness of short-term psychodynamic psychotherapy (STPP) for depression in a naturalistic setting utilizing a hybrid effectiveness/efficacy treatment research model. Twenty-one patients were assessed pre- and post-treatment through clinician ratings and patient self-report on scales representing specific DSM-IV depressive, global symptomatology, relational, social, and occupational functioning. Treatment credibility, fidelity, and satisfaction were examined, all of which were found to be high. All areas of functioning assessed exhibited significant and positive changes. These adaptive changes in functioning demonstrated large statistical effects. Likewise, changes in depressive symptoms evaluated at the patient level utilizing clinical significance methodology were found to be high. A significant direct process/outcome link between STPP therapist techniques and changes in depressive symptoms was observed. Alternative treatment interventions within STPP were evaluated in relation to subsequent improvements in depression and were found to be nonsignificant. The present results demonstrate that robust statistical and clinically significant improvement can occur in a naturalistic/hybrid model of outpatient STPP for depression.

Adult↗

PubMed2003

Further reliability, convergent and discriminant validity of overall defensive functioning.

The reliability, convergent and discriminant validity of the Defensive Functioning Scale (DFS) and the overall defensive functioning score (ODF) has been previously examined. This study aims to address gaps in the literature as well as to replicate and extend the initial positive clinical validity data emerging on the DFS ( Blais et al., 1996; Hoglend and Perry, 1998; Lingiardi et al., 1999; Perry 2001; Perry and Hoglend, 1998; Perry et al., 1998). Fifty-three outpatient clients were rated by clinicians trained on the DFS. The relationship between the ODF with both clinician-rated and self-report measures of psychopathology was examined. The mean interrater reliability for the DFS levels rated in this study was found to be moderate to high, and reliability for the ODF score was found to be excellent. Coefficient alpha of individual defense levels as well as across the entire DFS indicated high levels of internal consistency. Factor analysis revealed that the ODF represents a construct different from various aspects of patient self-report and clinician ratings of psychopathology. These results provide further support for the clinical application and relevance of the DFS system.

Adult↗

PubMed2003

Assessment of patient and therapist perspectives of process: a revision of the Vanderbilt Psychotherapy Process Scale.

The present study was designed to revise the Vanderbilt Psychotherapy Process Scale (VPPS), an external-rater completed measure, into both patient and therapist-rated versions. The VPPS was altered into two versions by using simple pronoun changes and then submitted to a principal components analysis in order to identify component factors. This procedure resulted in two identical forms of the VPPS, one completed by the therapist (VPPS-T) and one completed by patients (VPPS-P). These scales have identical items and factor structures. Preliminary results suggest that the VPPS-P and VPPS-T may be useful measures of psychotherapy process when perspectives of session activity is desired from both patients and therapists.

Adult↗

PubMed2003

Four studies extending the utility of the Schwartz Outcome Scale (SOS-10).

The Schwartz Outcome Scale (SOS-10; Blais et al., 1999) is a brief, cost free, and easy to administer assessment device designed to measure a broad domain of psychological health. The 4 studies using the SOS-10 reported here extend the initial reliability and validity studies beyond psychiatric patients in a hospital setting to examine (a) test-retest reliability in a college student population, (b) concurrent validity with college students using an indirect technique assessing maladjustment, (c) concurrent validity with college counseling center clients using a self-report measure of client distress, and (d) sensitivity to treatment changes with outpatient clients. These studies lend further support for using the SOS-10 as a measure of psychological well-being and as an outcome measure in varied settings.

Directive Counseling↗

PubMed2003

Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample.

This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.

Adaptation, Psychological↗

PubMed2003

Exploring the psychometric properties and construct validity of the MCMI-III anxiety and avoidant personality scales.

The Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983) is a commonly used self-report instrument designed to aid in the assessment of Axis I and Axis II disorders. Concerns have been expressed regarding the procedures used in the normative research for the current version of the MCMI (MCMI-III; Millon, 1994) leading to a call for additional validity research on the MCMI-III (Retzlaff, 1996). In this study, we investigated the psychometric properties of the MCMI-III's Anxiety and Avoidant personality scales in a sample of patients diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) anxiety disorders. Our results suggest that the MCMI-III Avoidant scale is reliable (r =.89) and it was found to demonstrate appropriate convergent and divergent validity with other self-report measures. The MCMI-III Anxiety scale also showed adequate reliability (r =.78); however, our findings raise some concerns about the discriminant validity of this scale. A scale composed of the MCMI-III core anxiety items was found to have better discriminant validity. These findings are consistent with those reported by other researchers regarding the relationship between self-report measures of anxiety, avoidance, and depression. We conclude that the MCMI-III measures of anxiety and avoidance are consistent with other measures of these constructs and may provide valuable clinical information in this regard.

Anxiety Disorders↗

PubMed2002

Distinctive activities of cognitive-behavioral therapy. A review of the comparative psychotherapy process literature.

The present review examined the comparative psychotherapy process literature in order to identify the distinctive activities of cognitive-behavioral (CB) treatment. Six techniques and interventions were found to distinguish CB from psychodynamic-interpersonal (PI) therapy: (1) use of homework and outside-of-session activities; (2) direction of session activity; (3) teaching of skills used by patients to cope with symptoms; (4) emphasis on patients' future experiences; (5) providing patients with information about their treatment, disorder, or symptoms; and (6) an intrapersonal/cognitive (C) focus. Identifying the distinctive features of CB therapy can improve the measurement of process-outcome correlations by more accurately specifying and operationalizing the treatment-specific processes of CB treatment, help researchers differentiate between common and treatment-specific factors, and aid in development of more psychometrically sound instruments assessing adherence and competence in CB therapy. In addition, this review can improve training of CB therapists by providing a guide for clinical practice.

Adaptation, Psychological↗

PubMed2002

An examination of interrater reliability for scoring the Rorschach Comprehensive System in eight data sets.

In this article, we describe interrater reliability for the Comprehensive System (CS; Exner. 1993) in 8 relatively large samples, including (a) students, (b) experienced re- searchers, (c) clinicians, (d) clinicians and then researchers, (e) a composite clinical sample (i.e., a to d), and 3 samples in which randomly generated erroneous scores were substituted for (f) 10%, (g) 20%, or (h) 30% of the original responses. Across samples, 133 to 143 statistically stable CS scores had excellent reliability, with median intraclass correlations of.85, .96, .97, .95, .93, .95, .89, and .82, respectively. We also demonstrate reliability findings from this study closely match the results derived from a synthesis of prior research, CS summary scores are more reliable than scores assigned to individual responses, small samples are more likely to generate unstable and lower reliability estimates, and Meyer's (1997a) procedures for estimating response segment reliability were accurate. The CS can be scored reliably, but because scoring is the result of coder skills clinicians must conscientiously monitor their accuracy.

Adult↗

PubMed2002

Rorschach Aggressive Content (AgC) variable: a study of criterion validity.

This study adds to the existing literature on the clinical utility of the Aggressive Content (AgC) variable proposed by Gacono and Meloy (1994). Criterion validity is evaluated by examining the relation between AgC and behavior. Rorschach and clinical chart material taken from psychological assessments were examined for 94 patients in Exner's (1993) psychiatric reference groups. An Aggression Chart Rating Scale (ACRS) was created to score the level of aggressiveness of each patient's diagnostic report. Analyses revealed good interrater reliability (intraclass correlation coefficient = .73) for ACRS scores and Aggressive Movement (AG; kappa = .73) and excellent reliability for AgC (kappa =.88) and Morbid Content (MOR: kappa = .79). Pearson's correlation revealed significant relations between AgC and both AG and MOR. All 3 Rorschach variables were significantly related to scores on the ACRS. A stepwise regression analysis utilizing these 3 variables resulted in AgC being the only nonredundant predictor of scores on the ACRS. This suggests that AgC was more strongly related to more aggressive ACRS scores than either AG or MOR. The continued support for the clinical utility of AgC as well as recommendations for the addition of the AgC variable to Exner's (1993) Comprehensive System's list of Special Scores are discussed.

Adult↗