Search

Abstract Background The abandonment of psychotherapeutic treatments is influenced by various factors, including patient characteristics, therapist traits, and the therapeutic relationship. Despite the well-documented importance of these factors, limited empirical research has focused on the role of the therapeutic relationship and the characteristics of therapist-patient dyads in predicting treatment dropout. This study protocol outlines a longitudinal research project aimed at predicting dropout and non-response in psychotherapy for individuals with personality disorders. The research seeks to identify predictive factors related to psychotherapy outcomes, focusing on patient, therapist, and dyadic elements. Specifically, the study will examine the influence of therapist characteristics (e.g., personality traits, countertransference, responsiveness) on treatment outcomes, explore the impact of relational factors (e.g., treatment expectations, epistemic trust, therapeutic alliance) on therapy effectiveness, and assess how the therapeutic alliance within therapist-patient dyads affects the likelihood of dropout and non-response. Methods The longitudinal study will include 100 therapist-patient dyads (200 participants) recruited from various Mental Health Services in Milan, Italy. Validated instruments will be administered to both patients and therapists at four-time points: T0 (baseline), T1 (3 months), T2 (6 months), and T3 (1 year). Data will be collected at baseline and at the one-year mark to evaluate the relationships between therapist, patient, and dyadic factors and treatment outcomes. Discussion Identifying predictive variables associated with high dropout rates can help preempt treatment discontinuation, reducing the financial and operational burdens on mental health services. Understanding these factors will enable the development of targeted interventions to improve treatment engagement and reduce attrition. This approach could enhance outcomes for individuals with personality disorders and lead to more efficient resource allocation and sustainable delivery of mental health care.

IntroductionPsychotherapeutic failures involve situational, relational, and personal factors. Dropout refers to a patient’s unilateral termination of treatment without the therapist’s knowledge or approval. Premature termination occurs when therapy is discontinued before achieving a sufficient reduction in initial problems.ObjectiveThis study explores the role of therapist’s emotional response (countertransference), gender, psychotherapeutic orientation, and patient diagnosis in the context of psychotherapeutic failures.MethodA mixed-method approach was used. Fifty-nine Italian psychotherapists, practicing mostly privately with at least 5 years of experience, were recruited through Italian professional internet websites. The Therapist Response Questionnaire and the Impasse Interview were administered to each psychotherapist. Each therapist was asked to reflect on their last dropout patient. Quantitative (MANOVA) and qualitative analyses (textual content analysis) were conducted with SPSS and T-LAB, respectively.ResultsThe quantitative analyses revealed that the most frequent countertransference response was Helpless/Inadequate, with female therapists experiencing this more frequently than male therapists. The qualitative analyses identified two main factors explaining most of the variance in countertransference responses: Parental/Protective versus Hostile/Angry, and Positive/Satisfying versus Helpless/Inadequate, with Helpless/Inadequate central. Additionally, the qualitative analysis of treatment interruption methods revealed two factors explaining over 50% of the variance. Lack of communication was linked to negative themes, while mediated and direct communication were associated with positive terms. Direct communication was characterized as useful, while mediated communication was linked to dropout and attachment figures.ConclusionUnder pressure, psychotherapists’ anxiety levels increase, often managed ambivalently or avoidantly. These results suggest that awareness of psychotherapist emotional responses is important to limit psychotherapeutic failures. These findings offer valuable insights for clinical practice.

When researchers and clinicians try to identify appropriate and effective ways to improve well-being among different populations, music is often included in interventions or research projects. The existing literature has consistently reported interactions between the effects of personality traits and music listening. However, the interrelations between individual traits and well-being after music listening are still partially unclear. This systematic review, registered on PROSPERO, investigates the relationship between everyday music listening, individual characteristics — operationalized as stable and transient personality traits — and well-being. Articles were searched on PubMed, Scopus, and Google Scholar, with a final result of 115 records. After eligibility screening, eight studies were included in the review. The results showed that both stable and transient personality traits influence music's effect on well-being. As a result of the scoping review, a theoretical perspective combining the emotional dimension, the principle of emotional congruence, and the dimension of music immersion and well-being was identified. Based on this knowledge, music listening could be systematically introduced into daily routines to improve everyday well-being and prevent or reduce stressful states.

BackgroundMentalization is an umbrella concept defined as the ability to interpret one’s and others’ mental states. Previous studies have hypothesized that mentalization may be a crucial resilience factor that significantly moderates the likelihood of developing psychotic disorders in individuals with both state and trait risk factors for the illness.PurposeThe study reviews the role of mentalizing abilities (e.g., reflective functioning, Theory of Mind (ToM), and metacognition) in young adults with At-Risk Mental States (ARMS) and schizotypal traits. Specifically, the objective is to include articles that (a) evaluate the links between low mentalizing and both state (ARMS/CHR) and trait (schizotypy) risk for psychosis (b) compare the differences in mentalizing abilities between individuals with ARMS, schizotypy, full-blown psychosis, and healthy controls.MethodElectronic databases (PsycINFO, PubMed, Scopus, and Google Scholar) were used to search for articles, while Rayyan was employed to facilitate the screening and selection of studies. Eligible studies are original English-language; peer-reviewed research articles on populations that met validated risk diagnostic criteria for psychosis, ARMS, and healthy controls; empirical studies evaluating the association or differences between psychotic risk and mentalizing abilities. Non-English language studies, the ones not considering state or trait risk for psychosis, and qualitative studies were excluded. After the application of the PRISMA checklist and the inclusion and exclusion criteria previously mentioned, 10 articles were extracted. The systematic review has been registered on Prospero (CRD42023397594).ResultsLow levels of reflective functioning and metacognition may predict a transition to psychosis. In addition, reflective functioning and metacognitive impairments are associated with attenuated psychotic symptoms in both state risk groups and in non-clinical individuals with schizotypal traits. Concerning ToM tasks, mixed results emerged.ConclusionThe results obtained from the review suggest that the application of strategies to attenuate maladaptive metacognitive beliefs and low mentalization may be equally effective in improving psychotic symptoms. The assessment of mentalization and metacognition could potentially provide additional prognostic value over factors predisposing to psychosis. Good mentalization and metacognition functioning should be considered as protective factors able to minimize the transition to psychosis.

BackgroundWorldwide, psychotherapists’ clinical experience went through rapid developments with transition to teletherapy during the COVID-19 pandemic. Literature on the use of remote psychoanalysis was not conclusive, leaving the issue of the consequences of the necessary setting alternation open. This study aimed to investigate the psychoanalysts’ experiences of shifting to remote work and then returning to in-person setting, considering the effect of the patients’ attachment styles and personality configurations.MethodSeventy-one analysts of the Italian Psychoanalytic Society were asked to fill out an online survey about patients who found the transition easier and patients who found it more difficult. General questions on therapeutic work, ISTS (Interpretive and Supportive Technique Scale) for interpretive and supportive aspects of technique, WAI-S-TR (Working Alliance Inventory-Short Revised-Therapist) for therapeutic alliance, RQ (Relationship Questionnaire) for attachment style, and PMAI (Prototype Matching of Anaclitic-Introjective Personality Configuration) for personality configurations were administered.ResultsAll of the analysts chose to continue the treatment using audio-visual tools. Patients with difficult transitions had a significantly higher frequency of insecure attachment and a higher score on RQ Dismissing scale than patients with easy transitions. No significant differences were found between the two groups in personality configurations, psychotherapeutic alliance, and psychotherapeutic technique. Moreover, a higher level of therapeutic alliance was positively correlated to RQ Secure scale and was negatively correlated to RQ Dismissing scale. Patients with easy transition both to remote work and back to in-person setting had higher scores of therapeutic alliances than those with difficult transition both to remote work and back to in-person setting.ConclusionOnline psychoanalytic therapy was widely used during the COVID-19 pandemic. Patients with insecure attachment styles had greater difficulties in adapting to setting alternations, thus confirming that insecure attachment is a vulnerability factor not only for psychopathological problems but also for a well-functioning therapeutic collaboration. Patient’s personality configuration did not influence their adaptation to the setting alternation. The supportive and interpretive styles did not undergo significant changes in the transition from in-person setting to remote setting and vice versa, thus suggesting a continuity in the analysts’ “internal setting.”

IntroductionSeveral studies have identified ultra-high-risk criteria that may characterize an at-risk mental state and predict the transition of psychotic evolution. Personality traits may play a crucial role in this process.AimsThe current study aims to: (a) explore the evolution of an initial diagnosis over 12 months; (b) assess differences in social and occupational functioning; (c) identify common (trans-diagnostic) personality traits of psychotic risk.MethodsThe sample includes 97 (44 males and 53 females) young adults. They completed an assessment that consists of socio-demographic data, the Social and Occupational Functioning Scale, the Early Recognition Inventory-retrospective assessment onset of schizophrenia, and the Personality Inventory for DSM-5 (PID-5). According to the tests’ assessment, the sample was divided into three different groups: Ultra-High Risk (UHR), At-Risk, and Not at risk. One year after the first evaluation, psychiatrists administered the QuickSCID-5 to verify the diagnostic trajectories of the sample.ResultsOverall, the most prevalent category diagnoses were anxiety/depression, personality disorders, and psychosis. Specifically, the most common diagnosis in the UHR group was psychosis. Moreover, in the UHR group, the social and occupational functioning score was the lowest. In terms of differences in PID-5 personality traits, the At-risk and UHR groups scored highest in detachment and disinhibition. No statistically significant differences were found between the groups for negative affectivity, antagonism, and psychoticism traits.ConclusionResults obtained by the current study should be considered an attempt to better understand the diagnostic trajectories and trans-diagnostic personality traits in a group of young help-seekers, specifically in UHR. Findings highlight both the importance of diagnosis and personality traits evaluation to customize a specific intervention based on the level of psychotic risk. Clinical suggestions are reported.

Introduction: Different studies confirm a stronger link between maladaptive personality traits and Non-suicidal Self-injury (NSSI). Additionally, the interest in the relationship between the experience of the COVID-19 pandemic and NSSI is growing. The present study aims (a) to investigate differences in personality traits between individuals with NSSI, suicidal ideation, NSSI and suicidal ideation co-occurrence and none; (b) to observe which personality traits predominantly influence the occurrence of self-harm acts; (c) to evaluate the difference in self-harm attitudes pre and post COVID-19 pandemic Method: 270 (108 males and 162 females) participants aged between 18 and 25 were included in the study. Everyone participated in a clinical interview and completed an assessment consisting of the Personality Inventory for DSM-5 (PID-5) and the Health of the Nation Outcome Scales (HoNOS). A multivariate analysis of variance (MANOVA), a multiple hierarchical regression analysis, controlling for age and gender and a T-test for independent samples were conducted. Results: The individuals with the highest levels of negative affectivity, detachment, antagonism, and psychoticism are those who simultaneously present suicidal ideation and NSSI. Moreover, age and detachment predicted higher scores in self-harm attitudes. Our results unexpectedly do not confirm an upward trend of NSSI and suicidal ideation during the pandemic period. Limitations: The study is cross-sectional, and no causal links can be assumed; the groups involved were not homogeneous for numerosity. Conclusions: The results testify that the study of maladaptive traits is fundamental to a greater understanding of NSSIs. Working clinically on those could potentially reduce

Coronavirus disease (COVID-19) continues to be a highly stressful event with a major impact on psychological mental health worldwide. The use of different coping strategies may change the perception of psychological well-being during the pandemic. The present study aims to explore psychological mental health in relation to sociodemographic variables and to analyze the coping strategies of the Italian population in dealing with COVID-19. Implications for clinical interventions are reported. A total of 537 individuals (>18) participated in the survey completing measures of sociodemographic data, general psychological well-being, and coping strategies. Results found that females, students, and unmarried people reported the lowest levels of well-being. Specifically, the coping strategy called positive attitude was positively correlated with psychological well-being, whereas avoidance and social support strategies negatively influenced well-being. Understanding beneficial coping strategies is central to optimally manage the long-lasting of the current COVID-19 situation and may be useful for mental health professionals in treating patients suffering psychologically from the pandemic.

Abstract Background Therapist’s emotional reactions toward patients in clinical facilities are a key concept in the treatment of personality disorders. Considering only clinical settings specialized in treatment of personality pathology the present paper aimed at: (1) assessing any direct relationship between patient symptom severity and therapist emotional response; (2) exploring patients’ functioning configurations that can be associated with specific therapist reactions (3) investigating whether these relationships remains significant when accounting for other setting variables related to patients or therapist. Methods The present study included 43 outpatients with personality disorders who underwent a psychotherapy treatment in two Italian facilities dedicated to outpatients with personality disorders and their 19 psychotherapists. The Symptom Checklist-90-Revised (SCL-90R) was used to explore clinical severity condition. Psychotherapists completed the Therapist Response Questionnaire (TRQ) to identify pattern of therapists’ response and the Shedler-Westen Assessment Procedure-200 (SWAP-200) in order to assess personality traits of the patients. Results No significant relationship between the clinical severity of the symptoms and the therapist’ responses was found. Even when controlled for clinical severity condition, duration of the treatment, age and educational level of the patient or years of therapist experience, most of SWAP-200 traits appeared to be significant predictors of therapist’ emotional responses. Conclusions The present study confirms the value of therapists’ emotional response as a useful tool in understanding psychological processes related to clinical practice highlighting its context-dependent dimension.

When shame and guilt emotional experiences related to stressful events remain unresolved, they can be related to psychological impairment and recursive thoughts. The present study aims to explore the association between state shame and state guilt related to past stressful experiences and psychopathological symptoms and evaluating a mediation role by immature defenses. A total of 90 participants (48.9% female; mean age 23.66) were considered in the present study to (a) investigate correlations between state guilt and shame scores related to personal stressful events and psychopathological symptoms related to global severity index; (b) assess whether state guilt and shame scores related to personal stressful events are positively correlated with immature defenses; (c) test whether immature defenses mediates the relationship between, respectively, state shame and state guilt with psychopathological symptoms. Significant correlations between state shame, state guilt, psychopathological symptoms, and immature defenses were found. Higher activations on immature defenses partially mediated the relationship between psychopathological symptoms and state shame and state guilt, respectively. Past experiences related to shame and guilt should be targeted by specific treatments that could help stop recursive maladaptive thoughts and empower more adaptive defensive strategies.

The goal of the present study is to explore the perception of the relationship with parental figures, traumatic experiences, personality traits and psychosocial characteristics of the participant sibling caregivers. The sample was composed of 30 sibling caregivers recruited at psychiatric facilities in Italy, and of 30 control siblings. The battery of instruments administered included Parental Bonding Instrument (PBI), Minnesota Multiphasic Personality Inventory 2 (MMPI-2), and The Inventory of Traumatic Experiences (TEC). This research found that sibling caregivers of patients with severe psychiatric pathologies are distinctly different from the siblings of the control group with respect to the perception of their relationship with parental figures more frequently regarded as dysfunctional, and were also characterized by a higher presence of traumatic experiences. The problematic relationship with parental figures, some traumatic experiences, and the burden of taking care of a sibling with psychiatric disorders are probably important variables with regards to the individual’s overall psychological condition.

The premature interruption of psychotherapeutic treatments is a significant phenomenon, with rates that can be above 50%, although differences emerge among studies. In general, the variables related to the psychotherapists have a significant effect on the treatment and a greater extent than the situational variables. In this study a multi-method research has been conducted to test the situations of impasse ending in dropout and the relationship between these situations and the covert narcissistic dimension of the therapist. Each participant was administrated the Impasse Interview, asking the therapist to focus on a salient or recent dropout case, and the Hypersensitive Narcissism Scale. The linguistic analysis of the interviews carried out with T-Lab produced 4 thematic clusters. Furthermore, as for the covert narcissistic dimension, 11 therapists reported a score below the average (Group A) and 9 scoring in the average (Group B). Finally, the association between the four clusters and the two groups of therapists was investigated. The therapeutic alliance and the emotional reaction of the therapist, influenced by his narcissistic dimension, represent key variables for the outcome of the therapy.

The effectiveness of psychotherapeutic treatments has been widely demonstrated and confirmed by many studies in recent decades. The research focused on the factors of change influencing the positive outcomes of a psychotherapy, putting those that are crucial in cases of failure into the background. The dimensions of this phenomenon are relevant as well as the side effects of the psychotherapeutic interventions that reach the same percentages of the pharmacotherapeutic treatments. The study of the variables involved in failure cases therefore seems important to prevent or moderate the negative effects of treatments with a negative outcome. Impasse and deadlock situations, which may result in an early interruption of psychotherapy, are often complex and involve situational, relational, and personal factors at different levels and with different weight. A research was conducted, with a mixed approach, aimed at exploring the situational factors involved in dropout cases. In addition, the evaluation of the psychotherapist’s emotional responses related to patients who terminated psychotherapy prematurely was investigated. The study was attended by a sample of 29 psychologists, experienced psychotherapists from different frameworks. Recent or salient cases of a hesitated psychotherapy with an early interruption were examined. For the first objective, a structured interview (Impasse Interview) was used, while the second one was reached by the administration of the TRQ (Therapist Response Questionnaire). The transcripts of the interviews were analyzed through a textual analysis software and five salient thematic clusters were identified. These were then assimilated to different areas of meaning: severity of the diagnosis, procedural aspects and lack of understanding of the stall in progress. Two other important themes emerged: the critical aspects concerning relational dynamics and a focus on maternal theme. Overall these five thematic areas seem to play an important and specific role compared to dropout cases. Finally, statistical analysis on emotional responses have highlighted some values above the average in these four countertransference factors: Helpless/Inadequate, Parental/Protective, Positive/Satisfied, and Overwhelmed/Disorganized. It is hypothesized that particular emotional responses of the psychotherapist may be prognostic with respect to the outcome of psychotherapy.

Background and Objectives: The diagnosis of psychosis is a challenge for the scientific community, both in terms of its definition and treatment. Some recent studies have investigated the relationship between personality and psychosis onset to prevent or intervene early. Materials and Methods: Sixty young adults were recruited during their first access in 2019 near the Community Mental Health Service of Niguarda Hospital, Milan, Italy. The assessment included the Social and Occupational Functioning Assessment Scale (SOFAS), the Global Assessment of Functioning (GAF) (clinician scales), the 16-item Version of the Prodromal Questionnaire (PQ-16), the Personality Inventory for DSM-5 (PID-5) (self-report), and a clinical session. Statistical analysis was performed by SPSS. Results: The results show a negative correlation between the Detachment domain and the GAF scores. Correlational analysis also highlights that all PID-5 domains, except for Antagonism, have positive correlations with high scores in the PQ-16. The multivariate analysis of variance showed that patients diagnosed with versus without a psychotic disorder significantly differed on Detachment, Antagonism and Psychoticism PID-5 domains. Conclusions: The involvement of the personality construct in psychopathological development is displayed. In particular, higher levels of Detachment and Psychoticism can distinguish people who are more vulnerable to psychosis or who already have overt psychosis from those who do not have a psychotic predisposition. The study highlights the fundamental role of personality traits, emerging from PID-5, to distinguish young adults at risk of onset.

Several studies have demonstrated that child maltreatment (psychological, physical, and sexual abuse, and neglect) may be a significant factor in the development of pathological personality traits that increase the risk for suicidal ideation and behavior from adolescence to adulthood. Currently, the challenge is to understand how different forms of early negative experiences render an individual prone to develop specific personality traits and, in turn, be more vulnerable to suicide risk. To understand the relationship between childhood maltreatment and personality dimensions in suicide risk, our study aims to explore the role of self-criticism and dependency, two different pathological personality traits, as potential mediators of the link between different types of childhood maltreatment and suicide risk in young adults. For this purpose, 306 students from three Italian public universities were recruited. We used the Italian version of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) to assess experiences of lack of care by parents (i.e., antipathy and neglect) as well as psychological and physical abuse before the age of 17 years. The Depressive Experiences Questionnaire (DEQ) was used to assess the personality dimensions of self-criticism and dependency, and the Suicide History Self-Rating Screening Scale was administered to assess suicide risk. Results revealed that lack of care and psychological abuse were significantly associated with suicide risk and this association was partially mediated by the maladaptive personality dimension of self-criticism. These findings suggest that the combined effect of specific forms of dysfunctional parental behavior during childhood and the development of rigid and dysfunctional negative personality traits may increase the risk for suicidal ideation and behavior during adulthood.

The current study evaluated the psychometric properties of the Italian validation of the Depressive Experiences Questionnaire (DEQ), conceived as a measure of self-criticism and dependency, i.e. two personality factors acting, according to Blatt (2004), as risk factors for depression in particular and psychopathology in general. A series of standardized measures [Beck Depression Inventory-II (BDI-II), DEQ, Symptom Checklist-90-R (SCL-90-R), Millon Clinical Multiaxial Inventory, 3rd edition (MCMI-III)] was administered to three samples (i.e., students, community and clinical). Factorial validity was evaluated along with convergent and predictive validity. In order to evaluate the reliability and internal consistency, a specific subgroup of participants was retested on the DEQ and BDI-II. Results showed correlations between DEQ dimensions and some personality traits of the MCMI-III. The traditional three-factor model of the DEQ structure as identified by principal component analysis appears to be as stable factors as typically found in American samples, although some items showed elevated cross-loading or low loadings on any factor. Clinical and diagnostic implications of the findings will be discussed.

A growing body of empirical and clinical research attests to the influence of personality features on the development, course and outcome of psychotherapy. Over the last four decades, Blatt adopted a psychoanalytic and cognitive developmental approach in developing a theoretically and empirically grounded two-configurations model of personality. The main aim of this study was to evaluate possible changes in anaclitic and introjective configurations – as measured by the Depressive Experience Questionnaire (DEQ) (Blatt, D’Afflitti, & Quinlan, 1976) – set against simultaneous changes in personality profile measured by Shedler-Westen Assessment Procedure (SWAP-200). Two young patients, a man and a woman, characterized by different personality profiles – introjective and anaclitic, respectively – were assessed for one year in the context of a psychodynamic psychotherapy. A battery of instruments – Beck Depression Inventory II (BDI-II), Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders I and II, Defense Mechanism Rating Scale, DEQ and SWAP-200 – were administered at the beginning, during the assessment process, and after one year. Both patients displayed lower BDI-II scores, along with evident clinical progress. Defence profiles and Core Conflict Relationship Themes showed interesting developments, in keeping with the evolution of the psychotherapy process. Lastly, while DEQ profiles outlined substantial stability after one year, some important changes in SWAP-200 profiles – in particular with regard to Q factors – were observed. Although these findings should be considered as preliminary, these results appear to be consistent with the description of Self-criticism and Dependency as relatively stable personality dimensions. The potential influence of profile diversity – introjective vs anaclitic – on other key variables of the psychotherapy process is also discussed.

Not available.