Exploration of personality factors and their predictive impact on therapy utilization: the externalizing mode of functioning.

The aim of this study was to identify personality factors predicting psychotherapy utilization on the basis of personality pathology, affect regulation and interpersonal functioning. The authors assessed affectivity (using the Affect Experience and Affect Regulation Q-Sort), interpersonal context (using the Quality of Object Relations Scale), and character pathology (using the Shedler-Westen Assessment Procedure-200). Combination of instruments showed one stable factor predictive for nonengagement in psychotherapy, revealing an externalizing personality dimension, dominated by externalizing defenses, acting out, deficient superego functions, and impairment in reflective functioning and in relating to others. Stability of the predictive power of this personality factor for therapy engagement could be shown, and replication in two other samples confirmed the findings. The results highlight the importance of measuring affect-regulatory mechanisms, and clinical implications for intervention techniques are discussed.