Gazzillo Francesco, Lingiardi Vittorio, Del Corno Franco, Genova Federica, Bornstein Robert F, Gordon Robert M, McWilliams Nancy
Department of Dynamic and Clinical Psychology, Sapienza University of Rome.
Derner Institute, Adelphi University.
Psychotherapy (Chic). 2015 Jun;52(2):238-246. doi: 10.1037/a0038799. Epub 2015 Apr 13.
The aim of this study is to explore the relationship between level of personality organization and type of personality disorder as assessed with the categories in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and the emotional responses of treating clinicians. We asked 148 Italian clinicians to assess 1 of their adult patients in treatment for personality disorders with the Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and the Personality Diagnostic Prototype (PDP; Gazzillo, Lingiardi, & Del Corno, 2012) and to complete the Therapist Response Questionnaire (TRQ; Betan, Heim, Zittel-Conklin, & Westen, 2005). The patients' level of overall personality pathology was positively associated with helpless and overwhelmed responses in clinicians and negatively associated with positive emotional responses. A parental and disengaged response was associated with the depressive, anxious, and dependent personality disorders; an exclusively parental response with the phobic personality disorder; and a parental and criticized response with narcissistic disorder. Dissociative disorder evoked a helpless and parental response in the treating clinicians whereas somatizing disorder elicited a disengaged reaction. An overwhelmed and disengaged response was associated with sadistic and masochistic personality disorders, with the latter also associated with a parental and hostile/criticized reaction; an exclusively overwhelmed response with psychopathic patients; and a helpless response with paranoid patients. Finally, patients with histrionic personality disorder evoked an overwhelmed and sexualized response in their clinicians whereas there was no specific emotional reaction associated with the schizoid and the obsessive-compulsive disorders. Clinical implications of these findings were discussed.
本研究的目的是探讨根据《心理动力诊断手册》（PDM；PDM工作组，2006年）中的类别评估的人格组织水平与人格障碍类型之间的关系，以及治疗临床医生的情绪反应。我们要求148名意大利临床医生使用心理诊断图表（PDC；戈登和博恩斯坦，2012年）和人格诊断原型（PDP；加齐洛、林贾尔迪和德尔科尔诺，2012年）对他们正在治疗的1名成人人格障碍患者进行评估，并完成治疗师反应问卷（TRQ；贝坦、海姆、齐特尔-康克林和韦斯顿，2005年）。患者的整体人格病理学水平与临床医生的无助和不知所措反应呈正相关，与积极情绪反应呈负相关。父母式且疏离的反应与抑郁、焦虑和依赖型人格障碍相关；仅父母式反应与恐惧型人格障碍相关；父母式且批评的反应与自恋型人格障碍相关。分离性障碍在治疗临床医生中引发无助和父母式反应，而躯体化障碍引发疏离反应。不知所措且疏离的反应与施虐和受虐型人格障碍相关，后者也与父母式且敌意/批评的反应相关；仅不知所措的反应与精神病态患者相关；无助反应与偏执型患者相关。最后，表演型人格障碍患者在其临床医生中引发不知所措和性化反应，而分裂样和强迫型人格障碍没有特定的情绪反应。讨论了这些发现的临床意义。
