Toward developing a scale to empirically measure psychotic defense mechanisms.

In recent years, research on psychological processes has greatly advanced our understanding of various psychopathologies. Defense mechanisms, for example, have been described as observable phenomena, and studies have shown meaningful relationships among these processes and other measurable dimensions of health and illness. Despite some notable exceptions, one area that has been overlooked is the empirical study of defenses in psychotic disorders. This is in part due to the lack of valid instruments measuring psychotic-level defenses. Propadeutic to creating an empirical scale for measuring psychotic defenses, the psychoanalytic and empirical literature on psychotic defenses is reviewed, after which the concept of psychotic defenses as measured by the P-DMRS (Psychotic-Defense Mechanism Rating Scales)--which can be used independently or in combination with the current DMRS (Defense Mechanism Rating Scales)--is operationalized. Finally, current research directions applying the P-DMRS to the clinical setting are presented, as well as its implications for guiding current clinical practice.

The measurement of interview structure in five types of psychiatric and psychotherapeutic interviews.

In a companion report (Beck & Perry, 2008), we reviewed the literature with regard to interview structure from which we derived seven operationalized quantitative measures. This report examines these measures as applied to five commonly used interview types--psychodynamic therapy sessions, dynamic interviews, Relationship Anecdote Paradigm (RAP) interviews, the Guided Clinical Interview and the Structured Clinical Interview for the DSM-IV axis I--each administered to the same six patients (n = 30). Two clinicians independently rated each interview using the Global Level of Interview Structure Scale (GLISS). Both the GLISS and six of the seven operationalized measures differed across interview types but not between subjects. Factor analysis yielded a single factor solution composed of five measures, not including a sixth measure (percentage of interviewer interventions that were questions) which was used as a solitary variable. Together the single factor and the percentage of questions predicted 75.2% of the variance in GLISS ratings, although no association was found between the factor and the percentage of questions. The GLISS and the operationalized measures captured distinct but complementary dimensions of interview structure. Discriminant analysis indicated that, on average, 80% of all interviews were correctly classified as to their type. Our main findings confirm that we can now accurately measure the degree of interview structure. Further research is needed to examine how these measures apply to other interview settings, such as psychoanalytic or cognitive-behavioral treatments, in the social sciences.

The definition and function of interview structure in psychiatric and psychotherapeutic interviews.

The concept of interview structure has been discussed in the psychodynamic, psychiatric, and psychodiagnostic testing literature as a factor which affects the form and depth of an informant's responses. However, the specific characteristics and clinical implications of structure have not been studied nor measured systematically. We define interview structure as a function of the degree to which the interviewer controls, directs, and shapes the verbal interchange between the two protagonists. This involves regulating the length, focus, and depth of the interviewee's discourse as well as imposing limits and direction through the interviewer's questions and interventions. Based on a review of the literature on interviewing in psychiatric, psychological, and other social sciences, we propose seven quantitative measures that operationalize aspects of the concept of interview structure. Measures 1 through 5 relate to quantity of speech and yield percentages and averages allowing one to compare speech production between subject and interviewer. Measure 6 reflects the way the interviewer shapes his interventions that are formulated as declarative demands or questions, as open, semi-open, or closed-ended. Measure 7 is the percentage of non-lexical or brief utterances from the interviewer that serve as mild reinforcing acknowledgements, such as "mm-hmm" or "I see." In a companion article, we examine how these measures converge with another construct of structure and discriminate five different types of psychiatric and psychotherapeutic interviews in common use.