@)15-1.*$#! This is a major study with potentially important implications. The Munich clinic carries a particularly high caseload of patients with borderline diagnosis and therapists have considerable experience of this group of clinicians with the methodology of psychotherapy research. Additional strength is offered to the project by the international collaboration with the Cornell Group.Personality Disorders Institute, Weill Cornell Medical College: Treatment development for personality disorders The Personality Disorders Institute (PDI) of the Weill Cornell Medical College, under the leadership of Otto F. Kernberg and John F. Clarkin, has the goal of investigating personality pathology, and developing empirically a psychodynamic treatment for these disorders. The empirical investigations of the PDI are guided by object relations theory which posits the centrality of internalized representations of self and other, and related affects in both the pathology and a central focus of therapeutic change (Kernberg, 1984; Kernberg, 2012; Kernberg & Caligor, 2005). In order to empirically investigate complex and clinically relevant object relations concepts, a self- report inventory and a semi-structured interview have been developed. The Inventory of Personality Organization (IPO) is a self-report instrument that measures the constructs of identity diffusion, primitive defenses, reality testing, aggression, and moral values (Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001). The object relations constructs in the IPO have significant associations with other key personality traits (Lenzenweger, McClough, Clarkin, & Kernberg, 2012). The Structured Interview of Personality Organization (STIPO) is a semi-structured interview which reliably assesses patients’ identity, defenses, quality of object relations, coping strategies, aggression, and moral values (Stern, Caligor, Clarkin, Critchfield, Horz, MacCornack, Lenzenweger, & Kernberg, 2010). The STIPO has been used to demonstrate personality organization changes following a dynamic treatment (Doering, et al, 2010). We have done extensive empirical work examining the nature of borderline personality disorder (BPD). We examined the criteria for BPD diagnosis by factor analysis (Clarkin, Hull, & Hurt, 1993), and found three factors in the condition: identity diffusion, affective dysregulation, and impulsivity. By using object relations theory combined with finite mixture modeling, we have isolated three groups of borderline individuals (Lenzenweger, Clarkin, Yeomans, Kernberg, & Levy, 2008). These three groups vary not only in terms of severity but also in terms of combination of adjustments to aggression, paranoid ideation, and antisocial traits. Aggression in BPD patients is influenced by the patients’ attachment style (Critchfield, Levy, Clarkin, & Kernberg, 2008). In a cross-cultural study with colleagues in Germany, we have used the Adult Attachment Interview (AAI) to examine attachment and mentalization in patients with co-occurring BPD and narcissistic personality disorder (Diamond, Levy, Clarkin, Fischer-Kern, Cain, Doering, Hörz, & Buchheim, in press). An object relations treatment for personality disorders has been detailed in two treatment manuals. Transference-focused psychotherapy (TFP) has been described for patients with BPD and borderline personality organization (Clarkin, Yeomans, & Kernberg, 2006). In addition, a version of this psychodynamic treatment has also been described for patients with higher level personality pathology (Caligor, Clarkin, & Kernberg, 2007). TFP for patients with borderline personality disorder has been empirically examined and supported in two randomized clinical trials, one in New York City (Clarkin, Levy, Lenzenweger, & Kernberg, 2007), and one in Europe (Doering, Hörz, Rentrop, Fischer-Kern, Schuster, Benecke, Buchheim, Martius, & Buchheim, 2010). In addition to symptom reduction, TFP resulted in an increase in narrative coherence and reflective functioning (Levy, Meehan, Kelly, Reynoso, Weber, Clarkin, &
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