Presenters:

Russell A. Meares, MBBS, MD, Acad DPM
Jon T. Monsen, PhD

Chair & Discussant:

Howard S. Baker, MD

Professor Russell Meares
Department of Psychiatry
University of Sydney
Westmead Hospital
Westmead NSW 2145
Australia
Fax: 61 2 9635 7734

The outcome data of 30 patients treated twice a week by trainee therapists supervised according to a model of psychology of self for one year are presented. Outcome criteria included number of days in hospital, suicide attempts, self mutilation, medication, days off work, and a symptom check list. On every criteria a the patient group showed significant improvement at one year, which was maintained, with the exception of days off work, at five years after cessation of treatment. There were no suicides. These findings are compared with outcome in such series as Stone's which concerned a less severe group of borderline patients. The good results in this trial are paralleled by Lyneham and Monson. Our discussion touches upon possible common features in the approach of these three apparently different forms of therapy. A convergence of the approaches is found in terms of the Kohutian model.

Personality Disorders, Affects and
Affect Consciousness:

Initial Testing of a Psychotherapy Model which Integrates Silvan Tomkins Affect- and Script-Theory within the Frameworks of Self Psychology

Authors: Jon T. Monsen, Torleiv Odland, Anne Faugli, Elisabeth Daae, Dag Erik Eilertsen

Abstract

Affects are significant factors influencing the organization of self-experience. Affect consciousness (AC) is operationalized as degrees of awareness, tolerance, nonverbal and conceptual expression of nine specific affects. A semistructured interview (ACI) and separate scales (ACS) reliably assesses affect organization. The level of AC may regulate whether specific affects rupture or sustain self-experience. The presentation outlines the AC concept and a psychotherapy model integrating Tomkin's affect- and script-theory within self-psychology.

The model was tested in a prospective follow-up study of 25 individuals with severe personality disorders and psychoses (mean treatment duration 25 months, mean follow-up 5 years). Change was assessed using standard psychotherapy research scales.

At termination, there were substantial changes in AC, characterological defenses and symptoms. 75% of patients no longer fulfilled DSM-III-R axis I diagnostic criteria. 72% no longer met axis II diagnostic criteria. High levels of stability persisted at follow-up. Patients showed improved capacity to establish and tolerate intimate relationships, better relationships with friends, improved socio-economic status, and reduced use of health and social services. At follow-up, HSRS and SCL-90-R scores suggest that 76% patients reached psychosocial and adaptation levels that can be defined as "no-caseness."