Structural Personality Organization as Assessed With Theory Driven Profile Interpretation of the Dutch Short Form of the MMPI Predicts Dropout and Treatment Response in Brief Cognitive Behavioral Group Therapy for Axis I Disorders

Abstract

We investigated the validity of theory driven profile interpretation of the MMPI (Hathaway & McKinley, 1943) Dutch Short Form (DSFM; Eurelings-Bontekoe, Onnink, Williams, & Snellen, 2008) 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.

Notes

¹It should be noted that the DSFM subscales Somatization and Extraversion are not included in the structural assessment model. Although these two scales are always used in the profile interpretation of the individual patient to refine the clinical picture, they are not used for structural diagnosis: Within the theory-driven profile interpretation, the DSFM subscale Somatization is considered to assess bodily awareness and as such to be an important general affect and emotion regulator, independent of structural pathology. Low scores on Somatization may be a complicating factor, irrespective of structural diagnosis, suggesting low or absent awareness of physical sensations, which can be considered as the first level of emotional awareness according to the alexithymia model of Lane, Quinlan, Schwartz, Walker, and Zeilin (1990). Extraversion is considered to be a (normal) temperamental trait and not a marker of structural personality pathology. This is in agreement with Kernberg and Caligor (2005) who argued that the dimension Introversion/Extraversion is a temperamental disposition influencing the type of PD (internalizing or externalizing) but not the severity of structural personality pathology.