Determinants and Outcomes of the Therapeutic Alliance in Treating Justice-Involved Youth: A Systematic Review of Quantitative and Qualitative Research.

A large body of research supports the role of the therapeutic alliance in predicting positive change in psychotherapy. This systematic review examined determinants of alliance quality and its association with treatment outcomes in an under-served and under-researched population-justice-involved youth-with whom several challenges and contextual considerations arise that bear relevance to the alliance. The search strategy yielded 23 independent studies meeting eligibility criteria and describing diverse treatments: 14 quantitative records synthesized narratively and nine qualitative studies that underwent thematic analysis. A complex picture emerged, precluding firm conclusions about factors linked to enhanced alliances and the alliance-outcome relationship with justice-involved youth. Nevertheless, some promising findings were noted across quantitative studies, including potential treatment benefits related to alliance growth and creating positive alliances with caregivers. The review also highlighted the potential relevance of the young person's relationships with peers and parents and their treatment readiness and expectations to alliance quality. Drawing on adolescent, caregiver, and therapist perspectives, the thematic synthesis of qualitative studies generated themes related to key elements of constructive alliances and their role in creating a foundation for initiating change. An integrated discussion is provided, highlighting practical implications and suggestions for addressing methodological limitations and substantive knowledge gaps.

A study of the relationships between rumination, anger rumination, aggressive script rehearsal, and aggressive behavior in a sample of incarcerated adult males.

OBJECTIVE: This study explored relationships between aggressive script rehearsal, rumination, and anger rumination with aggressive behavior. METHOD: One hundred and twenty-nine incarcerated males (M = 33.54, SD = 8.67) completed the Schedule of Imagined Violence, Preservative Thinking Questionnaire, Anger Rumination Scale, and the Life History of Aggression-Aggression subscale. Correlations were run to examine associations between the variables and a four-step sequential multiple regression was performed to assess for the unique contribution of rumination, anger rumination, and aggressive script rehearsal to aggressive behavior. RESULTS: Results revealed moderate-strong positive associations between aggressive script rehearsal, rumination, and anger rumination. Moderate-weak associations were found between these three constructs and aggressive behavior. Regression analyses revealed aggressive script rehearsal was uniquely related with aggressive behavior and path analysis demonstrated aggressive script rehearsal mediated the relationship between rumination/anger rumination and aggression. CONCLUSION: These results clarify the nature of the relationships between these conceptually connected constructs and suggest that the frequency with which someone rehearses aggressive scripts impacts on the likelihood of aggression more than anger rumination and general ruminative processes. The frequency with which a person rehearses aggressive scripts should be a critical consideration in violence risk assessment and treatment programs for people deemed to be at risk for violent behavior.

Aggressive Script Rehearsal in Adult Offenders: Characteristics and Association With Self-Reported Aggression.

This study explored the frequency, recency, content, severity, and targets of aggressive scripts reported by 94 incarcerated Australian males. The scripts of participants who reported a history of repeated and severe aggression were compared with the scripts of participants who reported a history of less severe and less frequent aggression. As hypothesized, participants with a history of more frequent and severe aggressive behavior reported more severe aggressive script content and more frequent script rehearsal. Furthermore, participants with a history of more frequent and severe aggressive behavior reported feelings of anticipation and excitement when they rehearsed aggressive scripts as well as an increase in the severity of aggressive scripts rehearsed over time. These results have important implications for risk assessment and treatment of violent offenders.

Aggressive script rehearsal in adult offenders: Relationships with emotion regulation difficulties and aggressive behavior.

This study explored relationships between self-reported emotion regulation difficulties, frequency of aggressive script rehearsal and aggressive behavior in 129 adult male inmates. Significant moderate positive correlations were found between the frequency of aggressive script rehearsal and (1) emotion regulation difficulties overall, as well as the following dimensions, (2) difficulties controlling impulses when experiencing negative emotions, and (3) confidence in the effectiveness of emotion regulation strategies. Significant weak positive correlations were found between the frequency of aggressive script rehearsal and two emotion regulation difficulty dimensions, (1) a lack of understanding of emotional responses, and (2) difficulties in dealing with goal directed behavior when experiencing uncomfortable emotions. No significant correlations were found between aggressive behavior and emotion regulation difficulties, except for a weak positive correlation between aggressive behavior and difficulties controlling impulses when experiencing negative emotions. Multivariate analyses were used to assess whether the frequency of aggressive script rehearsal moderated the effect of emotion regulation difficulties on aggressive behaviour. Significant improvement in the prediction of aggression resulted from consideration of the interaction between (1) aggressive script rehearsal and difficulties in emotional clarity, and (2) aggressive script rehearsal and awareness of emotional experience, even after accounting for the influence of age and attitudes toward violence. In conclusion, the results suggest that the rehearsal of aggressive scripts may function to regulate emotion, particularly amongst people who are inattentive to their emotions or who have difficulty understanding their emotional experiences.

The Personality Inventory for DSM-5-Brief Form: An Examination of Internal Consistency, Factor Structure, and Relationship to Aggression in an Incarcerated Offender Sample.

This study evaluated the internal consistency and factor structure of the Personality Inventory for DSM-5-Brief Form (PID-5-BF), and its relationship to aggression in 438 incarcerated Australian male offenders. Results provide support for the internal consistency and five-factor and bifactor structure of the PID-5-BF. The PID-5-BF total score, as well as the domains of Antagonism, Disinhibition, and Negative Affect (low), demonstrated significant relationships with aggression. These results provide preliminary support for the psychometric properties of the PID-5-BF within prison settings, and suggest that a PID-5-BF assessment may be useful within forensic settings to screen for broad maladaptive personality characteristics that are indicative of a greater propensity for aggressive behavior.

Assessing Schema Modes Using Self- and Observer-Rated Instruments: Associations With Aggression.

This study examined the associations between schema modes and aggression in 59 male forensic psychiatric inpatients. Two instruments were used to assess schema modes: One measured modes through self-report, the Schema Mode Inventory (SMI), and one measured modes via observer (nurse) judgments, the Mode Observation Scale (MOS). Aggression was measured in two ways: Self-reported aggression during participants' lifetimes was assessed using the Life History of Aggression-Self-Report-Aggression Scale (LHA-S-A), and incidents of aggression during hospitalization in the month following schema mode assessment, were identified through review of medical records. Self-reported (SMI) and observer-reported (MOS) measures of schema modes were poorly related and produced disparate associations with aggression. As hypothesized, the observer-reported MOS Angry-Child and MOS Impulsive-Undisciplined-Child modes were significantly associated with aggression during the follow-up. A number of other schema modes (MOS-Healthy-Adult, SMI-Angry-Child, MOS-Complaining-Protector, SMI-Undisciplined-Child, and MOS-Angry-Protector) were unexpectedly associated with aggression.

Psychopathy and the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition alternative model of personality disorder: a synthesis and critique of the emergent literature.

PURPOSE OF REVIEW: Including the psychopathic specifier within the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition alternative model of personality disorder (AMPD) trait conceptualization of antisocial personality disorder (ASPD) represents a significant development in the history of the conceptualization of ASPD and its relationship to psychopathy. This review presents a synthesis and critique of emerging literature pertaining to AMPD ASPD and the psychopathic specifier. RECENT FINDINGS: The current review draws attention to the utility of ASPD impairment ratings and traits to effectively measure psychopathy, shortcomings of the psychopathic specifier, research efforts to improve upon the conceptualization of AMPD psychopathy, and ASPD and psychopathic specifier trait complexity. SUMMARY: AMPD domains and ASPD designated traits converge with interpersonal, antagonistic, and disinhibitory domains of psychopathy but demonstrate poorer convergence with boldness/fearless dominance. The separate assessment of ASPD impairment adds little to the prediction of psychopathy beyond ASPD trait severity. Although the psychopathic specifier maps onto boldness/fearless dominance domains of psychopathy, theoretical and empirical limitations hinder the utility of the psychopathic specifier and reconceptualization will likely be required. Finally, complex ASPD and psychopathic specifier facet interrelationships and diverse relationships with externalizing outcomes suggests the development of advanced interpretive guides for clinical practice should be a high priority.

Associations between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, alternative model of antisocial personality disorder, psychopathic specifier, and psychopathy-related facets with aggression in a sample of incarcerated males.

Using the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), this study examined whether the Section III Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, alternative model antisocial personality disorder, psychopathic specifier, and three additional conceptually relevant psychopathy-related facets (Grandiosity, Perseveration, and Restricted Affectivity) were associated with aggression in a sample of 208 incarcerated males. Regression and commonality analyses revealed complex facet interrelationships, whereby common effects among the personality facets accounted for a comparatively greater or equal amount of variance in aggression history than facet unique effects. In particular, a nexus of antisocial personality disorder traits (Hostility, Risk Taking, and Callousness) emerged as the most influential facets within the model. In summary, the present study highlights that the personality drivers underlying aggression history were best characterized as trait overlap rather than trait independent. The complexity of these relationships suggests more research is required to reduce facet cross-loadings and maximize discriminant validity of the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Further, within clinical settings (a) the development of practical interpretive guides should be considered a high priority to assist clinicians working with aggressive offenders with complex maladaptive personality presentations, and (b) rehabilitation programs should prioritize trait hostility, callousness and risk taking, and emotional management as primary treatment targets to reduce aggression propensity. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The role of aggression-related early maladaptive schemas and schema modes in aggression in a prisoner sample.

Contemporary social-cognitive aggression theory and extant empirical research highlights the relationship between certain Early Maladaptive Schemas (EMSs) and aggression in offenders. To date, the related construct of schema modes, which presents a comprehensive and integrated schema unit, has received scant empirical attention. Furthermore, EMSs and schema modes have yet to be examined concurrently with respect to aggressive behavior. This study examined associations between EMSs, schema modes, and aggression in an offender sample. Two hundred and eight adult male prisoners completed self-report psychological tests measuring their histories of aggression, EMSs, and schema modes. Regression analyses revealed that EMSs were significantly associated with aggression but did not account for a unique portion of variance once the effects of schema modes were taken into account. Three schema modes, Enraged Child, Impulsive Child, and Bully and Attack, significantly predicted aggression. These findings support the proposition that schema modes characterized by escalating states of anger, rage, and impulsivity characterize aggressive offenders. In this regard, we call attention to the need to include schema modes in contemporary social-cognitive aggression theories, and suggest that systematic assessment and treatment of schema modes has the potential to enhance outcomes with violent offenders.

Investigating the Relationship Between DSM-5 Personality Disorder Domains and Facets and Aggression in an Offender Population Using the Personality Inventory for the DSM-5.

This study explored associations between aggression and the Personality Inventory for the DSM-5 (PID-5) domains and facets in 208 male offenders. Regression analyses revealed no significant domain-level relationships using either the APA-three facets only (Krueger, Derringer, Markon, Watson, & Skodol, 2013) or the Krueger, Derringer, Markon, Watson, and Skodol (2012) scoring algorithms. The PID-5 facets of Hostility and Risk Taking were significantly associated with aggression. These findings highlight the importance of a facet-level analysis when exploring the PD-aggression relationship. The authors call attention to how this knowledge can contribute to clinical-forensic practice and note limitations associated with using only PID-5 domain-level scoring approaches. More research is required to determine whether a universally accepted scoring approach can be adopted and promoted alongside future versions of the PID-5.