Elisabeth H. M. Eurelings-Bontekoe

Social functioning can be severely impaired in non-affective psychotic disorder (NAPD). Current models of psychosis pathogenesis do not tend to focus on social dysfunction and pharmacological treatment fails to ameliorate it. In this article, we propose that mentalization theory provides a valuable contribution to the understanding and treatment of NAPD. Impaired mentalizing may contribute to both positive and negatives symptoms as well as social dysfunction observed in NAPD. Furthermore, impaired mentalizing may help explain the relation between childhood abuse, insecure attachment and psychosis. Mentalization based treatment may contribute to the functional recovery of NAPD patients as it targets the social cognitive processes underlying social interaction. The article includes a description of the principles of MBT in general, specific characteristics of using MBT with patients with NAPD and a clinical vignette to illustrate these principles.

We investigated the validity of different subtypes of borderline personality organization (BPO) as assessed by theory-driven profiles of the Minnesota Multiphasic Personality Disorder (MMPI; Hathaway & McKinley, 1943 Hathaway, S. R. and McKinley, J. C. 1943. The Minnesota Multiphasic Personality Inventory., Minneapolis : University of Minnesota Press. [Google Scholar] ) Dutch Short Form (DSFM; Eurelings-Bontekoe, Onnink, Williams, & Snellen, 2008 Eurelings-Bontekoe, E. H. M. , Onnink, A. , Williams, M. M. and Snellen, W. M. 2008. A new approach to the assessment of structural personality pathology: Theory-driven profile interpretation of the Dutch Short Form of the MMPI. New Ideas in Psychology, 26: 23–40. [Crossref], [Web of Science ®] [Google Scholar] ) in a naturalistic follow-up study among 2,062 psychiatric outpatients who received 6 months of ambulatory treatment. Patients were assessed at intake (T1) and 6 months later (T2). At T2, both patients and therapists rated the level of improvement, using the Global Assessment of Improvement. Patients with the high-level BPO profile showed the largest increase in well-being and the largest decrease in severity of symptomatology, whereas severity of symptomatology and well-being of patients with psychotic BPO profiles did not change over time. Agreement between patients and therapists about improvement was good for the internalizing immature BPO and high-level BPO patients, but poor for the externalizing low-level BPO and narcissistic patients.

In this study, we investigated the relationships between features of personality organization (PO) as assessed by theory driven profiles of the Dutch Short Form of the MMPI (DSFM; Luteijn & Kok, 1985) and 2 self-report measures of personality pathology, that is, the Dutch Inventory of Personality Organization ( Berghuis, Kamphuis, Boedijn, & Verheul, 2009 Berghuis, H. , Kamphuis, J. H. , Boedijn, G. and Verheul, R. 2009. Psychometric properties and validity of the Dutch Inventory of Personality Organization. Bulletin of the Menninger Clinic, 1: 44–60. [Google Scholar] ) and the Dutch Schizotypy Personality Questionnaire–Revised ( Vollema & Hoijtink, 2000 Vollema, M. G. and Hoijtink, H. 2000. The multidimensionality of self-report schizotypy in a psychiatric population: An analysis using multidimensional Rasch models. Schizophrenia Bulletin, 26: 565–575. [PubMed], [Web of Science ®] [Google Scholar] ), in a sample of 190 outpatient psychiatric patients. Results showed that the single scales of all 3 measures segregated into 2 theoretically expected and meaningful dimensions, that is, a dimension assessing severity of personality pathology and an introversion/extraversion dimension. Theory-driven combinations of single DSFM subscales as a measure of level of PO distinguished characteristics of patients at various levels of PO in theoretically predicted ways. Results also suggest that structural personality pathology may not be fully captured by self-report measures.

We investigated the validity of theory driven profile interpretation of the MMPI ( Hathaway & McKinley, 1943 Hathaway, S. R. and McKinley, J. C. 1943. The Minnesota Multiphasic Personality Inventory, Minneapolis: University of Minnesota Press. [Google Scholar] ) Dutch Short Form (DSFM; Eurelings-Bontekoe, Onnink, Williams, & Snellen, 2008 Eurelings-Bontekoe, E. H. M. , Onnink, A. , Williams, M. and Snellen, W. M. 2008. A new approach to the assessment of structural personality pathology: Theory driven profile interpretation of the Dutch Short Form of the MMPI. New Ideas in Psychology, 26: 23–40. [Crossref], [Web of Science ®] [Google Scholar] ) as a measure of personality organization (PO) in a naturalistic follow-up study among 576 psychiatric outpatients receiving brief cognitive behavioral group therapy. Results showed that this assessment method was useful in predicting dropout as well as treatment response. Patients with a latent psychotic PO profile and a manifest low-level borderline organization profile were 3 times more likely to drop out than patients with other PO profiles. Patients with a latent psychotic PO profile who continued treatment had deteriorated at 4-month follow-up. Patients with a manifest low-level borderline PO profile who remained in treatment, however, showed considerable therapeutic progress. We conclude that theory driven profile interpretation of the DSFM as an assessment of PO may be useful in predicting dropout and treatment response to cognitive behavioral treatment of Axis I disorders.

In this study, we investigated the construct validity of the theory-driven profile interpretation of the Dutch Short Form of the MMPI (DSFM; Luteijn & Kok, 1985 Luteijn, F. and Kok, A. P. 1985. Herziene Handleiding NVM [Revised manual DSFM], Lisse, The Netherlands: Harcourt International. [Google Scholar] ), an interpretation method aimed at assessing structural features of personality based on Kernberg and Caligor's (2005) Kernberg, O. F. and Caligor, E. 2005. “A psychoanalytic theory of personality disorders”. In Major theories of personality disorder, , 2nd ed., Edited by: Lenzenweger, M. F. and Clarkin, J. F. 114–156. New York: Guilford. [Google Scholar] views concerning personality organization. We utilized the four dimensions of the Social Cognition and Object Relations Scale (SCORS; Westen, Lohr, Silk, Gold, & Kerber, 1990 Luteijn, F. and Kok, A. P. 1985. Herziene Handleiding NVM [Revised manual DSFM], Lisse, The Netherlands: Harcourt International. [Google Scholar] ) as external criteria. Results showed that, congruent with theoretical expectations, the DSFM profiles predicted structural features of personality functioning, especially identity diffusion as measured by the SCORS, after adjustment for the effect of the single scales used to construct the profiles. These findings provide further support for the construct validity of the DSFM profiles to measure structural features of personality organization. We discuss directions for future research and clinical implications.

The association between personality, attachment, psychological distress, church denomination and the God concept was studied among a sample of 208 subjects from the normal population. Subjects were Christians, members of an Orthodox reformed church or the Pentecostal church. Negative feelings towards God were associated with a high level of harm avoidance, insecure attachment and a high level of psychological distress. Psychological distress mediated the association between personality and attachment variables and negative feelings towards God. Psychological distress and church denomination were the only two independent predictors of negative feelings towards God. Moreover, results showed that the Orthodox reformed church members hold a more negative concept of God than the Pentecostal church members do. Orthodox reformed church members see God in particular as a punitive judge, independent of personality, attachment and psychological distress, suggesting a large influence of religious culture on this particular type of God concept. Results are discussed from a psychotherapeutic point of view. Finally, several ethical issues regarding psychotherapy with religious clients are addressed.