Perspective is everything: the predictive validity of six working alliance instruments.

The predictive validity of instruments commonly used to measure the therapeutic alliance was evaluated, using 46 sessions drawn from a clinical trial comparing manual-guided therapies for substance use. The California Psychotherapy Alliance Scale, Penn Helping Alliance Rating Scale, Vanderbilt Therapeutic Alliance Scale, and Working Alliance Inventory (Observer, Therapist, and Client versions) were rated for participants receiving either cognitive-behavioral therapy or twelve-step facilitation. All observer-rated instruments were significantly correlated with outcome; however, therapist-rated and client-rated instruments did not predict outcome. Findings suggest that the different observer-rated instruments are minimally different with respect to predictive validity, whereas patient- and therapist-rated measures may have a weaker relationship to outcome when highly objective outcome measures are used.

Addicted patients with personality disorders: traits, schemas, and presenting problems.

We evaluated the association of Structure Clinical Interview for the DSM-IV Axis II (SCID-II) severity and personality traits, early maladaptive schemas, and presenting symptoms in 41 methadone-maintained patients meeting criteria for either antisocial, borderline, avoidant, or depressive personality disorder. Correlational analyses indicated that the severity of each personality disorder was associated with a unique profile of presenting problems and underlying traits and schemas. The evaluation of multiple psychological indicators appears to be a useful method for case conceptualization and planning interventions within a promising individual therapy model that focuses both on substance abuse and psychiatric symptoms and maladaptive schemas and coping styles.

Deconstructing dependency in a five-factor world: a meta-analytic review.

Meta-analysis of studies assessing the relation between interpersonal dependency test scores and five-factor model (FFM) domain scores revealed that dependency scores are positively correlated with FFM Neuroticism and Agreeableness scores and negatively correlated with FFM Extraversion, Openness, and Conscientiousness scores. The magnitudes of these correlations were all in the small-to-moderate range, and comparable score intercorrelations were obtained when participants' dependency levels were assessed by means of a trait dependency questionnaire, dependent personality disorder questionnaire, or dependent personality disorder interview. These findings have implications for researchers' efforts to deconstruct dependency into its basic trait elements and for the dimensional approaches to personality disorders being considered for future versions of the Diagnostic and Statistical Manual of Mental Disorders.

Concurrent and predictive validity of antisocial personality disorder subtyping among substance abusers.

Three hundred seventy inpatient and outpatient substance abusers were divided according to presence and subtype of antisocial personality disorder (APD) into groups comparing: a) adult antisocial behavior (AAB) versus full APD; b) APD with low versus high sociopathy; c) APD with versus without lifetime depression; and d) APD with versus without other axis II disorders. Multivariate regression was used to predict the unique contribution to the variance in baseline and 12-month follow-up measures of substance use, psychiatric severity, and personality. The presence of comorbid axis II pathology was the strongest predictor of baseline severity in all three domains. APD substance abusers with lifetime depression exhibited greater baseline to follow-up reductions in psychiatric severity than those APD substance abusers without a history of depression. All APD subtypes improved over time with treatment, suggesting that this diagnosis does not necessarily indicate poor prognosis.

Word association profiles of alcoholics.

A group of 100 alcoholic outpatient men were compared to 100 control participants, matched for race, age, and occupational status on 15 scales of the Karp Objective Word Association Test. Consistent with 2 of the 3 specific hypotheses of this study, a one-way multivariate analysis of variance found significant differences between the groups, with alcoholics offering more rejections (nonresponses) and more hostile associations than controls. Unexpectedly, alcoholics offered more synonyms than controls, congruent with a more positive diagnostic picture.

Alexithymia and affect pathology among adult male alcoholics.

The present study attempts to validate earlier findings of a positive relationship between the severity of alexithymia and symptoms of affect pathology among alcoholics. One hundred adult male outpatient alcoholics were given instruments to assess alexithymia and symptoms of affect pathology. Controlling for alcoholism severity, Pearson Product Moment Correlations demonstrated that the severity of alexithymia was significantly correlated with dysphoria and affect intolerance, as well as with certain interpersonal difficulties resulting from these affective disturbances. Such findings support the usefulness of the alexithymia construct in the understanding and treatment of affect pathology and its consequences among alcoholics.