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Through detailed analysis of case examples, this work seeks to provide valuable insights for clinicians wishing to explore suicidality with their patients in ways that are informed both by existential and attachment-based perspectives. Specific case studies are used to explore and illustrate areas of intersection around the topic of suicidality using Interpersonal Reconstructive Therapy (IRT) theory and Terror Management Theory (TMT) lenses together. Intersecting themes focus on meaning-making, attachment, and how these together inform how patients experiencing chronic suicidal ideation appear to overcome the evolutionary desire to survive. In this view, suicidality can be seen as a maladaptive attempt at adaptation, miscued by learning about perceived safety and threat signals derived from close attachment relationships. Implications for theory, research and practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives: This study tests ways in which the perception of intergenerational continuity in parenting behaviors among child‐maltreatment (CM) and non‐CM families conform to Benjamin's (2006) Copy Process Theory, which considers three copy processes: Identification (be like him/her), Recapitulation (behave as if he/she is still present and in charge), and Introjection (treat myself as he/she treated me). Method: Across two home visits and a laboratory session, 171 mothers of preschoolers (M = 3.7 years) completed the SASB Intrex Questionnaire relative to herself, her history with her parents, and her present relationship with her child. Results: Mothers' retrospective reports of her interactions with caregivers were correlated with the quality of self‐reported parenting processes in interactions with her preschooler. Analyses indicated high rates of intergenerational copying in both samples for each copy process. While copying in general was observed in nearly all mothers (roughly 80%−90%) and emphasized warm, securely attached patterns, the copying of hostility and/or lack of affiliation occurred in copied profiles for about one‐third of mothers. About the more problematic profiles, CM mothers tended to rate themselves as being in the child‐like position they experienced in their own childhood, with themes involving hostile control perceived from their child. By contrast, non‐CM mothers copied disaffiliative themes primarily in relation to themselves. Conclusion: Findings verify that interpersonal patterns and internalized relational histories are important keys for understanding CM risk. The use of a method that offers interpersonal specificity at the level of individual profiles has application to clinical practice with at‐risk parents. [ABSTRACT FROM AUTHOR]

Clinical work with clients suffering from personality disorders can be among the most challenging for psychologists. These clients may have a wide range of clinical presentations, and many practitioners may lack the specialized training needed to provide successful treatment to these clients. Clinicians are faced with several challenges in making treatment decisions that are ethically informed and based on available research findings. Because of the relative dearth of evidence-based treatments for these clients, clinicians are encouraged to use a cost-benefit analysis approach when weighing the benefits versus disadvantages of specific interventions and treatment approaches. Recommendations for effective and ethical treatment of clients with personality dysfunction are provided that are based on an empirically grounded framework. Three expert commentators provide insights into the state-of-the-art of clinical work with these clients. Keywords: ethics, personality disorders, cost-benefit analysis, evidence-based treatment, principles of treatment DOI: 10.1037/a0017733

Feature heterogeneity and diagnostic overlap occur regularly among patients in clinical settings. In interpersonal reconstructive therapy (IRT), a case formulation focused on patterns learned in close attachment relationships guides intervention choices. This study illustrates how IRT formulation and treatment proceed, and how it may also fail when there is not close adherence to underlying principles. Don is a music professor in his 40's with a significant trauma history and complex diagnostic profile that includes many hospitalizations and suicide attempts. He qualified for several diagnostic and statistical manual of mental disorders personality disorders via formal diagnostic interviews (obsessive‐compulsive, avoidant, passive‐aggressive, narcissistic), as well as major depression, generalized anxiety, and substance abuse. Don's formulation demonstrates how self‐destruction can function as a "gift of love" to internalized representations of important caregivers. Data from work with patients like Don confirm the usefulness of Benjamin's IRT lens for navigating comorbidity, as well as the importance of underlying principles of change. [ABSTRACT FROM AUTHOR]

Studies connecting childhood experience and adult psychopathology often focus on consequences of abuse and neglect. Copy process theory (Benjamin, 2003) states that constructive as well as destructive experiences shape adult behavior with surprising interpersonal specificity. Childhood perceptions and social learning are encoded in memory and then 'copied' in 3 basic ways in subsequent relationships: Identification (behaving as he or she behaved), Recapitulation (behaving as one behaved when with him of her), and Introjection (treating oneself as he or she was treated). The first step in evaluating copy process theory is to verify that the predicted correspondence between adult relational patterns and internal representation of early experience can be observed in different adult samples. Remembered interpersonal patterns from childhood and perceptions of adult relational patterns were measured using the Structural Analysis of Social Behavior (SASB). Strong evidence was found for each copy process in a sample of psychiatric inpatients (N = 161) and a college sample (N = 133). Positive and negative behaviors were copied in both. Evidence suggests that gender, patient status, and rated state may influence whether, and in which forros, copying occurs.

Attachment theory provides a framework for understanding and predicting critical aspects of aggression in the personality disorders. An association between borderline personality disorder (BPD) and insecure forms of adult attachment marked by high relationship anxiety has been repeatedly observed in the empirical literature. Aggression also has been linked to insecure attachment. The present study extends previous work by exploring the degree to which the underlying attachment dimensions of relationship anxiety and avoidance are associated in BPD with the following forms of hostility: (a) direct aggression (verbal or physical) initiated towards others, (b) expectation/perception of aggression from others (including 'reactive' counteraggression when/if provoked), (c) aggression directed towards the self in the form of suicidality or parasuicidality, and (d) affective experience of irritability or anger. The issue was studied in a sample of 92 patients diagnosed with BPD. Results show significant association between more fearful forms of attachment (simultaneous presence of relationship anxiety and avoidance) and the more reactive form of aggression involving expectation of hostility from others. Self-harm was significantly associated only with relational avoidance while anger and irritability were associated only with relational anxiety. Implications for understanding relational aspects of BPD aggression in research and clinical work are discussed. Keywords: borderline personality disorder; attachment; aggression

Early sessions from three variants of cognitive-behavioral therapy (CBT) were examined to replicate work done in psychodynamic-interpersonal treatments linking interpersonal process to outcome (W. P. Henry, T. E. Schacht, & H. H. Strupp, 1986, 1990). Cases were available from a component study of CBT for generalized anxiety disorder (T. D. Borkovec, M. G. Newman, A. L. Pincus, & R. Lytle, 2002) and were selected to form good and poor outcome groups maintained through a 1-year follow-up. A third group was also examined that had initial positive outcomes and marked decline by follow-up (n = 8 for each). Structural analysis of social behavior (SASB) was used to identify interpersonal behaviors. Contrary to the authors' expectation, SASB variables were not strong predictors of outcome, and lower levels of interpersonal hostility were found than was the case in previous work. Findings are discussed in light of differences observed between treatment variants and the role that manuals may have in standardizing some aspects of the therapeutic relationship. Keywords: structural analysis of social behavior; cognitive-behavioral therapy; generalized anxiety disorder; interpersonal process; psychotherapy

A wide variety of clinical problems and relational styles are collected under the diagnostic heading of personality disorder (PD). These disorders involve maladaptive, persistent ways of thinking, feeling, and behaving that are associated with both functional impairment and disturbed interpersonal relationships. Personality disorders are difficult to treat, and challenge a therapist's ability to intervene helpfully, in part because the maladaptive patterns can impact the therapy relationship itself. Therapeutic principles were derived by Task Force review from the small body of research conducted to date with this family of disorders and include characteristics of clients and therapists, their relationship together, and essential elements of technique. The importance of a collaborative relationship as well as a treatment that is comprehensive, empathic, patiently applied, and flexibly tailored to presenting problems are dominant themes across principles. Treatment research with PD is in its early stages and many important areas remain uncharted. The Task Force principles are here summarized in hopes of providing general guidance to clinicians working with PD, as well as to outline research needs for the area. Keywords: psychotherapy; personality disorders

A present challenge in our field is that diverse and frequently comorbid patterns of personality disorder are not sufficiently addressed by existing evidence-based treatments. Authors in the special section describe promising efforts to address this challenge, including case examples illustrating the utility of each approach. Each approach is consistent with evidence-based principles of change, suggesting the possibility of placing them together within a meta-theoretical integration frame (Magnavita and Anchin in Unifying psychotherapy: Principles, methods, and evidence from clinical science, Springer Publishing Co, New York, 2014). Common threads include use of an individualized case formulation to tailor treatment to diverse patterns; incorporation of affect, behavior, and cognition; and modification of attachment-linked, internal templates using both didactic and experiential forms of learning. Interpersonal Reconstructive Therapy (IRT), our favored approach, offers a similar language and framework, leaving technical choices to the clinician so long as they are consistent with an attachment-based, interpersonal case formulation, and are helpful in establishing new patterns toward adaptive goals. Work with IRT suggests ways to extend further the focus on internalized representations. Direct conversation with "family in the head" can be used to enhance ways of being, thinking, and feeling that allow distance and differentiation from problematic internalizations of loved ones. The authors present suggestions for future research, emphasizing the therapeutic relationship as well as the need to measure therapeutic optimality in a tailored, context-specific manner focused on mechanisms of psychopathology and change. [ABSTRACT FROM AUTHOR]

This study evaluated the associations between relationship distress, depression symptoms, and discrepancy in interpersonal perception within couples. After completing a series of discussion tasks, couples ( N = 88) rated their behavior using the circumplex-based Structural Analysis of Social Behavior Model ( SASB; Benjamin, 1979, 1987, 2000). Overall, couple members were strikingly similar in their interpersonal perceptions, and tended to see themselves as friendly, reciprocal in their focus, and balanced between connection and separateness. As hypothesized, however, perceptual discrepancy was related to relationship distress and depression. Relationship distress was associated with discrepancy regarding transitive behavior focused on the partner, while depression was associated with disagreement about intransitive, self-focused behavior. Analysis of affiliation and autonomy revealed that relationship distress was associated with seeing oneself as reacting with more hostility than the partner sees, and perceiving one's partner as more hostile, more controlling, and less submissive than he or she does. Partners of depressed individuals viewed themselves as more controlling than their mate did. Men's depression was associated with disagreement between partners regarding men's self-focused behavior. Results underscore the importance of considering interpersonal perception when conceptualizing relationship distress and depression within intimate relationships. [ABSTRACT FROM AUTHOR]