Level Of Personality Organization As A Predictor Of Referral For Analysis: A Preliminary Report

There are currently no empirically validated indications for psycho- analytic treatment. The goal of this study is to find standardized measures that predict referral for analysis. This is a first step toward testing the validity of criteria used to recommend analysis to patients. Level of personality organization, or “structural diagnosis” (Kernberg and Caligor 2004), is a systematic diagnostic framework that categorizes patients according to severity of psychopathology using psychoanalytic constructs. We anticipate that the results of standardized assessments of personality organization will correlate with clinical assessment provided by analytic clinicians. In contrast, we expect the results of other, nonanalytic standardized assessment batteries will not. Our sample will include all patients evaluated for psychoanalytic treatment in the clinic of the Columbia University Center for Psychoanalytic Training and Research between October 2002 and October 2006. We expect to obtain initial assessment data for approximately 120 patients and anticipate that approximately half of these patients will be accepted for analysis.

We report here on a preliminary sample of 25 patients who have completed the research and clinical evaluation process. Forty-four percent were accepted for analysis with a candidate; 56% were rejected and referred for other treatments. Sixty-nine percent of the patients in the total sample were diagnosed with a high borderline level of personality organization, 40% had current affective illness, and 88% had a lifetime prevalence of affective disorder. As predicted, the accept/reject groups were indistinguishable across the standardized assessment measures analyzed thus far, including Axis I diagnoses, level of social adjustment, and symptoms of depression and anxiety. Contrary to expectations, level of personality organization did not predict acceptance/rejection for analysis. However, we did not anticipate the very narrow distribution of personality o