Honoring Paul Lerner's Legacy in Psychology

It's a great honor this morning to introduce our first master lecturer who is going to give an informative talk this morning. But first let me just mention, as some of you may see on the slide, that this is is the first Paul Lerner Memorial Master Lecture. Many of you know or knew Paul Lerner, who was a staunch supporter of SBA. for many years, a fixture at the SBA conventions for many years, who was beloved by many people because of the warmth, compassion, and empathy that he showed for his clients and for the the richness that he imparted to his interpretation of psychological tests. The Lerner family made a very generous gift to the Society for Personality Assessment in honor of Paul and his devotion to the Society for Personality Assessment, which is why this session has been named the Paul Lerner Memorial Master Lecture. So, and it will be so named going forward from now on. So it is now my great pleasure to introduce Dr. Aaron Pincus, who is a professor of psychology at Pennsylvania State University. I can't possibly say... Enough about him and so I'm not gonna try but instead I'm gonna turn the introduction over to Chris Hopper So when I was in my first year in my doctoral program at Texas A&M, I was struggling to try to become a proficient researcher, to try to become a proficient clinician, to try to think about how those two things go together. And I went to my advisor Les Mori's office and I sort of talked with him about these struggles. I said, what do you think? And he said, well, in his sort of wise, terse way, you could think about it this way, and he handed me a book. And in the book was a chapter by Aaron on interpersonal theory and how it applies. in the clinic. And I read the chapter and all of a sudden I started to have an answer to the question of if I see a patient this way and the patient does this thing in a session, how can I have a model-based, evidence-based way of thinking about what I should do in response that's not an abstraction about how you take a manual to a patient in a diagnostic group but answers a much more molecular question about how you can use personality science to inform your interactions in the consulting room. That was a transformative experience for me reading that. that chapter. So my reaction to that was I got to meet this guy. And so I learned that he was a former president of a small society called the Society for Interpersonal Theory and Research. I bought a ticket to go to the meeting and I met him and that was the second transformative experience for me. I think it's appropriate, at least from my personal experience, that Aaron is giving the inaugural Lerner master lecture because, from my experience, I love Aaron for the same reasons that I love SBA and I think it's the same things that Lerner. who I never had the fortune to meet, really valued and brought to the society. The first is generativity. So I look in the crowd and I see Oliver and students, all of whom are now leaders in the field, in practice and research, and certainly he's had that impact on me. The second is the science of personality. Aaron was trained by Jerry Wiggins, a giant in the field of personality science and clinical psychology, and he's had a career full of really impactful scientific work in personality psychology. But the third is the application of personality science to the consulting room, the thing that really impacted me initially. So what I love about SPA is that we really bring those three things together. It's a very student supportive group who values personality science, clinical practice, and mostly how you put those three things together. And that's really the way that I. I see Aaron. I'm sure that you'll see Aaron the same way as you watch him give his talk. Aaron? Well, thanks very much. I'll let you know I understand I'm standing between you and lunch today, so we will make sure you get there on time. And I only hope to do at least half as good a job as Phoebe did yesterday. So I do want to thank us. for asking me to do this master lecture. I'm really honored to give the Paul Lerner Memorial Master Lecture. Today I'm going to be talking to you about contemporary interpersonal assessment from personality dispositions to personality dynamics. And I think this is a very apropos topic for the Paul Lerner Memorial Lecture, because Paul had a deep appreciation for the interpersonal context of personality assessment. And in his 2009 article honoring Paul, our own F. Barton Evans said that Paul Lerner is perhaps the most pure example of an interpersonal approach to personality assessment. So I hope the things I'll talk to you about today can honor that. And before I get started, I have to thank... a large number of people. I want to thank my mentors and my students and my former students and my collaborators. These are really my interpersonal super friends. And I wouldn't be here without the luck of having these people, these really amazing people, to work with and to learn from. And I'm basically going to be presenting a lot of their work as examples today of the contemporary interpersonal paradigm. That was a fun slide to make, by the way. So, a little bit of history, of course. These are what I would consider to be the founders of the interpersonal paradigm, most of whom you probably know and recognize. Harry Stack Sullivan, Tim Leary, Maury Lohr, Don Kiesler, Bob Carson, Lorna Ben-Jones, Jerry Wiggins and Len Horowitz and boy am I lucky I pretty much except for Sullivan and Leary met all of these folks and had some collaborations and has really impacted me positively. The stuff I'm going to talk about today really rests on the foundations of the work of these people spanning some six decades. But what I want to do is kind of turn it forward and say what's happening right now in the field of interpersonal assessment. Also just thank the society. The interpersonal paradigm has been well represented at SPA over the years and both Jerry Wiggins and Lorna Benjamin are former Bruno Klopfer award winners. So this just feels right at home for me. I'll give you a quick outline of what I'm going to talk about today. I'm going to outline the contemporaries. assumptions of interpersonal theory and assessment. And I'm going to talk a little bit about personality dispositions in terms of a concept called interpersonal pathoplasticity, which I'll explain downstream. And then shift to talking about personality dynamics, which are some of the most, I think, exciting advances in interpersonal theory. I'm going to talk about structural dynamics. I'm going to talk about temporal dynamics on two different kinds of time scales, moment-to-moment interpersonal functioning and also assessing interpersonal function. functioning in daily life. So here we go. So let's just first orient ourselves through the contemporary assumptions of interpersonal theory and assessment. All right. So I'm going to start with the first one, which is the idea of the theory of the universe. And I'm going to start with the idea Now, my view is it's been evolving and growing, and in 2013, Emily Ansell and I said, whether it's referred to as the interpersonal paradigm or the interpersonal system or the interpersonal tradition, this approach to personality and social functioning is evolving into a meta-theory for psychological science. And the reason it is is it provides a very integrative nomological net that you can use to look at personality, personality assessment, psychopathology, and psychology. pathology, psychotherapy, and health in a completely integrative way. And it's been that kind of approach that I've taken through most of my career. One of the reasons I think we can call this a meta-theory is its ability to integrate perspectives. So most personality theories and clinical theories certainly touch on and sometimes emphasize relational, social, interpersonal. context and the interpersonal tradition really can integrate these. So just some examples that we've written about and touched on from the psychodynamic tradition. We might talk about things like Blatt's relatedness and self-definition. which is highly interpersonal, or Kernberg and Clarkin's transference and object relations approaches. Attachment has been integrated with interpersonal theory. Lorna Benjamin and Lynn Horowitz did quite a bit of work looking at how the internal working models and adult attachment styles are, in fact, emphasizing interpersonal functioning. The pure interpersonal approach, the paradigm, may be more focused on the here and now. Interpersonal transactions and relationships, great paper last year in JPD. by Chris Hopwood talked about that. I also love Clara Hill and her concept of therapeutic immediacy, which is really about an interpersonal exchange between the therapist and the client. We also have social cognitive theories that focus on social interpersonal functioning. We have Ken Locke and Pam Sadler talking about the idea of interpersonal efficacies. We can talk about someone's expectancies, their efficacies, their interpersonal beliefs and in a really fabulous synthesis in the early 90s by Jeremy Safran who integrated cognitive theory and interpersonal theory and that was very influential on my thinking about things. There's evolutionary mandates about social functioning, interpersonal functioning, the benefits that one gets by having a social dominance orientation and recognizing the need to belong and in the 80s Bob Hogan would refer to that as getting ahead and getting along. And even Richard Depew has good evidence for neurotransmitter systems and neurobiological systems focusing on interpersonal functioning like agentic extroversion and affiliation. So we can take all of these and have them inform looking at things through the interpersonal paradigm. time. At least that's how I do it. So let's talk about the assumptions that will organize the work that I'll present today. So the first assumption comes straight from Sullivan, of course. The most important expressions of personality and psychopathology occur in a phenomenon involving more than one person. So here's three interpersonal situations we all might be familiar with. On the left, we're having a good time chatting with friends. That looks like Chris and I if his hair was a little longer. The middle one probably needs no explanation as to why that's an important interpersonal situation for personality development. And maybe on the right, something unfortunate happening on the playground, but also an important event to impact the person's sense of self and other. So, come on up. There we go. Emily Ansell and I have defined the interpersonal situation as the experience of a pattern of relating self with other that's associated with varying levels of anxiety or security in which learning takes place that influences the development of self-concept and social behavior. So sort of a contemporary restatement of some very basic Sullivanian ideas. So that's the first assumption. The second assumption is one that I think is important to emphasize for people who might not be so familiar with the paradigm, and that has to do with clarifying the nature of the interpersonal and the intrapsychic world. What we really want to think of when we hear the term interpersonal interpersonal is that it's focusing theory on some fundamental phenomenon that are important to know about for personality development, organization, function, and pathology. But it's not referring to simply proximal behaviors between two people that we can observe. That's not the only place that interpersonal situations occur. So they also occur not only with that observable behavior that's going on in the proximal moment, but also in perceptions, memories, mental representations, expectancies, and fantasies. So we have proximal interpersonal interactions, but we also have interpersonal situations in the mind. And we can consider both of those to be interpersonal. And that's an important part of the process. of expanding the paradigm and integrating the paradigm. So it's not just a behavioral focus. It's a focus on how we represent and think and feel about our relationships and our sense of self and other. The third assumption is how are we going to talk about the important facets of interpersonal functioning? And we do it through the constructs of agency and communion. These come from Bacon, but developed further by Jerry Wiggins and many of the other people I showed you. If we use agency and communion as our fundamental constructs, and perhaps use them as two axes to create a two-dimensional space, what we... do is we create a conceptual map that can describe interpersonal situations and the sort of famous instantiation of that is the interpersonal circle, the Leary circle, or many other versions of that name and I'm going to show you several versions of that today. We use the interpersonal circle to describe, understand, and measure both normal and abnormal interpersonal dispositions and also interpersonal dynamics, and that's something we'll get to through the lecture today. We can apply the interpersonal circle as a map not only to the objective description of observable behavior and interaction, say, between therapists and clients, but also to the interpersonal situations evoked in the mind through perception, memory, mental repression, expectancy, and fantasy. So I feel like I have this iconic interpersonal circle sort of in my brain, and I kind of organize my experience of the world many times through that lens. Can't help it. Now, as an interpersonalist, I like circles. So I want to digress for a minute and talk just about circles as organizing structures just for a moment before I get into details. They say that nature may abhor vacuums, but it seems to like circles, as does human nature. And some examples of this... Here's the zodiac, perhaps organizing our vision of the heavens. The Buddhist wheel of life, which hopefully we can hop off of at some point if we're working the program well. The color wheel. which has some empirical basis for the associations and placements of the colors as it goes around the positions of it. So circles are very, very useful organizing structures, I think, in nature and in human life, but also in psychology. So we've also used a lot of circular structures in psychology. In the study of emotions, we have a two-dimensional circular model of affect and mood. Some people refer to the axes as valence and arousal. Some people talk about the axes as being negative affectivity, positive affectivity, but it's still the same two-dimensional space and just a matter of preferred rotations. And we've even been able to show that you can map out that circle. on facial expressions of emotion. So this is kind of a, not the, you know, interpersonal functioning is not the only place we use these. There's circular structures used in the psychology of vocational preferences, right? We have the famous RAI-SEC vocational preference circle, which was based on the seminal work of Holland. And if you've been on a university campus or been to a university counseling center, you know, this gives rise to the rather famous. what color is my parachute vocational preference circle. So we do use this in a variety of different assessment kinds of situations. But let's now return to the interpersonal circle itself. So back to agency and communion, we can look at the interpersonal circle in a very broad, sort of what we call a meta-construct way that says that it's organized at different levels of specificity and functioning. So, of course, the y-axis here is the agentic axis, running from power mastery assertion at the top to passivity, weakness, failure, submission at the bottom. Communion is the x-axis. which may run from intimacy, union, solidarity with others, to dissociation, a remoteness, a hostility, a disaffiliation from others, and that this can be understood as expressing things at various levels. So at the sort of broadest level, we might talk about interpersonal motives, and your motive might be to be in control, and because of that, you're going to express your disposition of dominance, and in the proximal moment, that might mean... having some directive behaviors that you enact. Or you might have the motive to be close to others, expressing a disposition of nurturance, and then enacting a friendly behavior, something I seem to rarely do. Yes, that was a joke. But what I love about this is we can think about interpersonal functioning at so many different levels, and this is important. To understand things clinically, I think. This is probably the most famous instantiation of the interpersonal circle. This is the interpersonal circle of traits and interpersonal problems. So we go from agency and communion in that sort of broad way to the dispositions of dominance and nurturance. And each point around the circle is... a blend of these two fundamental dimensions. So gregariousness, extroverted is a blend of being dominant and warm. Being unassuming and possibly exploitable is a blend of being warm but submissive. Being introverted is a blend of being is a blend of being submissive and cold, and being kind of arrogant or calculating or vindictive, that's a blend of being dominant and hostile, and dominant and cold. So we can actually make as many fine-grained splits as we want in the circle, but the most common model tends to use these eight octants as a reliable way of measuring and assessing that. But we can find the circle in other places. I just wanted to show something that in 1996, Jerry Wiggins, his favorite cartoonist was William Stieg, the New Yorker cartoonist. And Jerry was able to find the same interpersonal structure in the corpus of William Stieg's New Yorker cartoons. We call this the Stiegenplex. And I don't know that everyone can see it, so I'll just walk around it. At the top, most dominant, he says, I recreated myself. In the hostile dominance, I know my rights. The cold-heartedness, I don't forget to be angry. Aloofness, people are no damn good. Submissiveness, why pick on me? Sort of warm submissiveness. If you're good-natured, they'll step all over you. Affiliation, a woman who can really love. And dominant, warm position, I can laugh at myself. So we really... find the interpersonal system and the interpersonal circle in pretty much anything that has social implications including cartoons in the New Yorker. So that's my homage to Jerry. This was published in JPA by the way. So we've now covered three contemporary assumptions. I have one more to go before we get into some fun stuff. My computer will forward. There we go. The last one is, the last basic assumption is reciprocal influence. So the assumption is that interpersonal behavior doesn't happen in a vacuum, it doesn't happen randomly, that it creates reciprocal influences on interactants, and reciprocal patterns can be defined in the terms of the interpersonal circle based on agency and communion, dominance and nurturance. So here's a couple of reciprocal interactions. Maybe on the left, there's some cold hostility kind of being met with a little bit of cold hostility. And on the right, there's some loving, getting some loving back. And these are just examples of how in the immediate moment, interpersonality behavior is having a reciprocal influence on what's going to happen next. We actually have a way of mapping that out according to the interpersonal model. So let's figure that out really fast. We first think of interpersonal transaction cycles, this ongoing interactions between people, whether it's happening in your mind or it's happening proximally. In this case, I sort of put this slide, let's get into the consulting room, think about therapist and patient, and we can enter into that ongoing transaction at any point, but we'll just start with the patient having a covert reaction to whatever the therapist might have said or done, and that's now the patient's input to try to understand the moment, what's going on in the relationship. following that. The patient's going to have some actual reaction based on their interpretation of it. That's the patient's output. And the patient's output is immediately the therapist's input. Now the therapist has a reaction to what the patient has said or done and is trying to make sense of it along with the goals of what the therapy is aiming to do. And then the therapist makes a choice. How do I respond to the patient? And this continues to cycle through over and over and over again as we watch a patient's reaction to the therapy. a relationship or an interaction develop. And we now have ways of assessing the process of transaction cycles moving forward in time. And I'm gonna show you some examples of that later today. Now we can map these transaction cycles with reference to agency and communion. And we have a principle in the interpersonal paradigm called complementarity, which helps us map those transactions. So there's our circle again. Complementarity is a set of principles that says we expect, in a probabilistic way, that there will be correspondence or sameness on nurturance, that warmth tends to beget or invite warmth back. Coldness tends to beget or invite coldness back, and what we call reciprocity or oppositeness on dominance, that a dominant act is an invitation to perhaps follow one's lead, and a more submissive act is an invitation to follow one's lead. to sort of take control, take the lead. These are not basic just stimulus response cycles. There's a lot of stuff going on in the mind to get there, but we do have lots of empirical data that say this is kind of a common baseline in at least our Western culture's socialization. So part of it is about human development and child development. So in the West, I think we are socialized to be relatively warm and friendly and to be sort of flexible as far as whether we're going to be taking the lead or following the lead. following the lead of someone else. And so that's sort of the common baseline of interpersonal functioning. So that's what we want to think of it as, this kind of complimentary patterns. If Chris says something very warm to me, I'm gonna tend to be very warm back. This is the common baseline of these sort of field regulatory polls and invitations. Jerry Wiggins wrote a great paper with Krista Tropst on the fields of interpersonal behavior and talking about these kinds of impacts. So again, it's not. not simple stimulus response, a lot of things go into maintaining a complementary pattern or not, but if you think of it as a common baseline, a sort of probabilistic expectation, then people who show chronic deviations from these complementary reciprocal patterns, they can't follow when someone offers to lead, they can't take the lead when someone needs it, they're not very warm to someone who's trying to be close to them, that maybe if this is chronic, these are indicators of some pathology, some abnormal functioning, something that needs to be addressed therapeutically. At least in the culture I grew up in. So now I'm going to take those four assumptions, the interpersonal situation, the clarification of the interpersonal and the intrapsychic, our framework of agency and communion, and the idea of interpersonal influence and reciprocal influence, and I'm going to turn the rest of the talk to sort of showing you some of the most contemporary work that's going on in the interpersonal field by a lot of the people that I was thanking earlier today. So the first thing I'm going to do is talk about interpersonal dispositions. I'm going to talk about the concept of interpersonal pathoplasticity, which I tend to promote as the idea of enhancing diagnosis with interpersonal dispositions. And the idea here is I know more as a clinician in my first session if I know both what my patient's diagnosis is and what their interpersonal characteristics are. And that might actually move the therapy forward more quickly than if I have to learn that without an assessment. And we... And we've been demonstrating a variety of ways in which there are relationships between personality and particularly in the interpersonal approach and psychopathology. And one kind of personality psychopathology relationship that I know Tom Whitaker has written about is pathoplasticity. And that's actually where I learned about it first was from some of Tom's writing. So let me talk a little bit about what I mean by interpersonal pathoplasticity and show you some of the research that's been done. So we know what interpersonal dispositions are. are. There are general tendencies, regularities, and relating self and other. My patient tends to be shy and withdrawn. My patient tends to be chronically argumentative. My patient tends to be highly dependent. If we know these things interpersonally and we think about them through the lens of the interpersonal circle and all of its associated information, we can ask some very important therapeutic questions right away that are based on the more than the diagnostic label itself. What expectancies, schemas, fears, motives underlie my patient's behavior? What impact does the patient have on others or on the therapist? How is the patient's behavior linked to their symptoms? These are things we study. How can I behave in ways that are going to facilitate a therapeutic alliance, even with, say, an argumentative, domineering kind of patient? And how can I tailor treatments for optimal effectiveness? So I'm still trying to figure out how to do CBT with sort of argumentative, hostile, dominant patients, and this helps me figure out some ways to do that. So... Interpersonal pathoplasticity is essentially combining the diagnosis with the interpersonal style to sort of jumpstart your clinical work with a patient. And, of course, there should be empirical evidence for this. So in this model, the symptoms, typically we used to call it Axis I. We don't call it Axis I anymore. But the symptoms are contextualized within the personality. But there's some important relationships we need to be clear on. Usually using either cluster analytics. techniques or latent profile analytic techniques, there are interpersonal subtypes identified. We usually give some measure of the interpersonal circle to the patients, a group of patients, and through these agglomerative techniques, we find these subtypes within the same presumably homogeneous diagnostic clinical samples. And important kinds of aspects to clarify a pathoplastic relationship from other kinds of personality psychopathology relationships are that typically we find no differences. in these subtypes, these interpersonal subtypes, no differences on symptom severity at the time of diagnosis. So it's not severity that's sort of driving the interpersonal subtypes. We find very few differences on diagnostic comorbidities. So it's not different comorbidities that are driving these different subtypes. So they're non-eteological relationships. They're not causal, but having a certain interpersonal style in combination with a certain diagnosis does not mean does seem to impact the presentation of the disorder, the course of the disorder, the treatment response, and of course has those implications for forming the alliance and for tailoring your treatment. So I wanna do today, right now, is sort of show you some of the more recent research on pathoplasticity that have been published lately. All right, so we've done this, and other colleagues have done this, several of them are here today, so I hope I do justice to it. We found interpersonal subtypes of the pathoplastic nature in generalized anxiety disorder, in social phobia, in major depression, in post-traumatic stress disorder, bulimia, and some other diagnoses. And what I'm going to do today is just let me review some of what we've learned so far using this approach. The first one I'm going to talk about is generalized anxiety disorder. I have probably the most to do with this one. And this all started when a colleague of mine, Tom Borkovic, who's a well-known cognitive behavioral therapist for anxiety and for many years at Penn State, was one at work. was running RCTs for his cognitive behavioral treatments of GAD, and he asked me, how could I better predict who's going to attrit from my RCTs? And I said, I think we should assess their personalities. That's going to predict something, and suggested we... We used the IIP, which is one of our measures of the circle. And it did turn out that the more cold GADs are the ones who had TRIT. We sort of had predicted that. But we also found that there was actually more subtypes to look at. So this is what we found in two well-diagnosed clinical samples of GAD. So according to the DSM-IV, these patients are the same. They all meet criterion for the diagnosis, GAD. They all have uncontrollable worry. they meet all of those kinds of symptom criterion. We find four groups in two different clinical samples that really replicated quite well. In each quadrant of the circle, an intrusive group, an exploitable group, a non-assertive group, and a cold group. And each type has the same core uncontrollable worry that defines GAD, but when we ask them what they worry about, we find they worry about different things. So... So the exploitable, warm, submissive GADs tend to worry about, do you like me? Are we okay? Is there anything wrong between us? Did I offend you in some way? And the non-assertive GADs tend to worry about, can I do it? Will there be help available for me? Will someone be there if I need them? The cold GADs are kind of concerned, are you going to hurt me? Are you going to take something away from me? And interestingly, the intrusive GADs, their number one worry tended to be, to be punctuality, like I'm concerned whether I'm going to get to the party on time. They were concerned about things like that. Another way I tend to try to describe what the kind of implications of this are is, so what will happen is someone like the warm, submissive, exploitable GAD is going to get quite anxious if you break a date with them. Cold GADs are going to get quite anxious if you make a date with them. It tends to tell you what you really need to know. We also know that the more submissive subtypes of these groups, the more exploitable and non-assertives, do better in standard CBT treatment for GADs. This is mainly learning anxiety management skills and things like that. At both end of treatment and at six-month follow-up, they're maintaining their gains and doing better than the two agentic subtypes. And we've talked about whether that's possibly some difficulties with the role relationship in cognitive behavioral therapy and who's going to be the expert and who's going to be the learner. So these submissive types tend to carry the benefits of CBT out further. Another anxiety disorder study, Nicole Kane and colleagues looked at social phobia and found two subtypes that of course look similar in space to two of the GAD subtypes and I think they may have similar fears and anxieties. socially. But interestingly, no agentic subtypes. And I like to point out this to show you that if you use this kind of technique with the circle and LPA or cluster analysis, you're not just guaranteeing you're going to find four subtypes every time because there's, say, four quadrants in the circle. It really depends, as you'll see, on the psychopathology you're studying. And these folks went through not a very, they didn't go through an RCT for treatment. They kind of went through any kind of treatment as usual within their clinic in Europe that they thought was appropriate for the patients. And what we did find in this study was that the warm submissive sociophobics did better. And at the end of treatment, they were functioning better socially and personally, and they had better self-esteem and all the things that we like therapy. to help our patients acquire, they were doing better than the non-assertives. And this actually replicates some work from about 20 years ago from an old mentor of mine, Lynn Alden, who did this with avoidant personality disorder and found, again, two similar types, and found that the warmer type of avoidant PD did better in treatment than the colder type. Nicole Keynes and her colleagues have also looked at it in terms of major depression. And this is using, I think, data from the CLIP sample. And they found some very interesting results. So now we find... all diagnosed with major depression, all meeting criterion at the point of diagnosis. So DSM is saying they're all homogeneous in terms of their mood disorder, but we actually find, or she actually found, six different interpersonal subtypes that. that again don't differ on severity, modest comorbidities. And they found some very interesting results about the long term chronicity and functioning. So in this study, after controlling for some PD diagnoses, what Nicole found and her colleagues found was that the submissive GADs, the ones that sort of lack agency and maybe they're also a little cold, relatively speaking, given their position at the bottom there in the green, that they follow up on 10 years of chronicity and function. And this submissive group spent over 177 weeks over 10 years with a rating of 5 or 6 on depression on the psychiatric status rating scale. And they also had poor functioning having over 52 weeks with a GAF rating under 70. And that's compared for instance to the dominant and extroverted groups who tended to have about one third as many weeks with these kinds of symptoms. kinds of ratings over 10 years. So there's something about the lack of agency and maybe the lack of communion that's sort of impacting how the person's functioning with their depression over the course of 10 years. It also means you can be extroverted and depressed, though, so that's something that you can take away from that, too. In a very recent study, also looking at chronicity and functioning, Kate Thomas and colleagues looked at the same kind of approach with PTSD. And here they found four groups, basic quadrants, warm dominant, cold dominant, warm submissive, cold submissive. And the cold submissive PTSD group, again, that bottom green one, showed again the worst chronicity over 10 years, spending nearly 500 weeks at least meeting partial diagnosis for PTSD after 10 years. That means literally over the entire 10-year period, they continued to meet at least partial diagnosis for PTSD. Compared to the warm dominant and the cold dominant, the agentic groups, which had less than half of that. that time. spent meeting at least partial diagnosis. So they seem to be resolving more quickly and having better functioning and less chronicity. Now, in summary, what we might take away from these examples is that cold, submissive interpersonal styles, that sort of lack of agency, lack of communion, impact depression, PTSD, and social phobia negatively. But remember, the agentic GAD patients actually didn't do so well at the end of CBT. It was the submissive GADs that were doing better than the agentic ones. So it's not just one rule across the board. But I think... what's important to note there is it was only those GAD patients that went through a highly controlled RCT therapy outcome study and that the others were having a sort of more therapy as usual or different kinds of therapies so I think the next step we want to take in figuring this out is to start looking at some subtype by treatment interactions to see if we can understand which treatments are going to be tailored well for which kinds of patients so then again I can do that thing where I know my patient is GAD, but I also know what their interpersonal style is, and I can have a better sense of how to move the therapy forward quickly. So that's my talk on dispositions today. That's all the stuff I'm going to say about dispositions today because I really want to spend the rest of the time today shifting gears and talking about assessing personality dynamics, which to me is the newest stuff in the interpersonal paradigm. So the first kind of dynamics I'm going to talk about is structural dynamics. And this comes from psychodynamic ideas that there are conflicts and balances in the processes and functions of the mind. And we're thinking about the personality dynamics of the individual. And in the interpersonal tradition in the 50s, Tim Leary actually proposed that there were five levels of interpersonal conceptualization that you could think of in the person. Now we don't use in the contemporary paradigm Leary's actual levels, but instead we now have several different measures of interpersonal constructs that all conform to the agency and communion system. They all have the same structure, but they measure different specific interpersonal constructs. And we can use multiple surfaces, multiple assessment instruments to get at sort of what are balances and conflicts within the individual's personality. And I'm going to give you an example of that today using a multi-surface interpersonal assessment. To do that, let me just introduce some of you who may not be familiar with the different surfaces you could choose to develop an assessment battery for your patient. All right. So we have several of these that can be used as self- reports, informant reports, they're all well validated, they all conform to the structure of the interpersonal circle. Of course a famous one, general traits, Wiggins interpersonal adjective scales, assesses general interpersonal style. We have Kenlock's circumplex scales of interpersonal motives, or sorry, interpersonal values, which rates the importance of various interpersonal experiences for the person around the circle, so some people say it's really important that I'm seen as income- control and strong and agentic and others say it's really important that I'm seen as warm and supportive so on and so forth they rate how important the various interpersonal behaviors are for them efficacies are what they of course sound like develop again by Ken Locke and Pam Sandler how confident are you that you can enact various interpersonal behaviors that are mapped around the circle can you be dominant when you need to be can you be cooperative when you need to be can you be loving when you need to be etc Don Kiesler developed an interesting measure called the impact message inventory. This is actually used where the rater describes their own reactions to the target. So how does interacting with that target person actually make me feel? What does it make me think about? What do I think is going on there? All conforming to the interpersonal circle model. There's several others. Probably the most well-known in the clinical assessment is the inventory of interpersonal problems. And this really assesses distressing interpersonal extremes and inhibitions. The measure says it's hard for me to do certain interpersonal things, or I do certain interpersonal things too much and I'm distressed by this. There's a new measure out that Chris Hopwood and colleagues developed that I really like called the interpersonal sensitivities circumplex. This assesses interpersonal behaviors that you say others do that bother you. So this is a really new idea but it actually conforms very well to the interpersonal. circle. And we have the inventory of interpersonal strengths, which describes sort of highly adaptive interpersonal features around the entire circle. So even they were working very hard to say there are ways to be adaptively cold and distant. when you need to be in order to make sure you can be separate when you need to and still be able to connect when you need to. So what I'm going to do now is I'm going to present a case, and I owe a lot of the material here to Aidan Wright. because I really want to give you the clinical flavor of this, I'm going to do a little bit more reading now to present to you a case where we used a multi-surface interpersonal assessment and I'll walk you through this case and give you a lot of clinical details. the slide in a minute, but I've got to introduce the patient and the therapy for you first. So I apologize to read. I don't want to miss it. So this is a case of Mr. S. Mr. S was enrolled in a prestigious and competitive graduate engineering program. And to those that knew him, he was, and by his own admission, he was bright and had various intellectual interests, but he was socially awkward with few close friendships. However, in therapy he had started dating a younger undergraduate woman, and this was was his first real romantic relationship, first serious relationship. Now diagnostically, the majority of his complaints were well captured by DSM-5 diagnoses of major depressive disorder, recurrent, moderate, without psychotic features, and narcissistic personality disorder. And he was being seen for twice weekly transference-focused psychotherapy that was mainly focusing on his personality pathology. Some of the features of narcissism that were really predominant in the... case. He had overvalued ideals and expectations for himself and others. He had an exquisitely experienced shame when things weren't going the way he hoped they would go. He had a ruminative focus on how others had wronged him and had accompanying rage over that. He was devaluing of many people and things, including his advisor and the program he was in and his lab mates and others. he would protectively withdraw when things were not going well. He would kind of check out. And all of this left him quite vulnerable to experiencing intense bouts of suicidal depression. And although he had been in psychotherapy for over two years, he and his new therapist, he had just started a transfer to a new therapist a couple of months before the assessment. And it was this transfer that kind of led to the idea of an assessment to jumpstart that new segment of therapy. And this was largely motivated by Mr. S's consistent pattern of stating that he didn't feel there was anything to say in sessions. And a review of the case notes suggested that this pattern was presaged. It had occurred with the previous therapist. And it was successfully but slowly addressed through interpreting the subtle devaluation of saying, I have nothing to say when I come to therapy. and sort of implying therapy can't be helpful. So an alternative approach, an assessment approach was taken that was meant to bypass the sort of vulnerability this fellow felt with opening up in session and talking about himself. So what did we do? We invited him to be collaborative about it, to ask his own questions about what the assessment might be able to reveal, and we decided on a multi-level battery. And the battery that we used... was a traits circle, a strength circle, a value circle, a sensitivity circle, and a problem circle, and these are his scores. So what we can look at on these scores, and I'll show them to you in a couple of different ways, is if we think about his trait profile, profile, what it tells us, I know it's a little small for those of you in the back, but trust me. It was apparent from his trait profile that he viewed himself as prototypically withdrawn and aloof. That was his way of seeing himself generally. And in terms of interpersonal strengths, there were none. That he felt he had excelled at no interpersonal behaviors, he felt generally ineffectual to some degree, everything on that. profile is below the T score of 50. It's all negative. His sensitivities profile was interesting because most of it was negative. It suggested he really wasn't bothered very much by other behaviors, by others' behaviors most of the time. Didn't really care too much, wasn't negatively impacted with the one exception of when others maintained distance from him and withdrew from him. This is really what he was most sensitive to. In terms of his values for interpersonal functioning, he generally valued being warm and agreeable, which was decidedly in contrast to the characteristically aloof style that he attributed to himself. And finally, when you think of his interpersonal problems profile, it was highly elevated, suggesting a lot of interpersonal distress, but it wasn't a particularly prototypical profile. There were peaks in some opposing places. scores included problems with being too warm and problems with being too aloof, which suggests some kind of conflict between how close and how distant he wanted to be in relation to others, because that's relatively opposite interpersonal conflict. context. Now we can take these scores and put them up on a profile, map them, and see some discrepancies and some convergences that help us make interpersonal interpretations. So for example, we see that as far as being cold or having distance from people that... lost my place here for a second, excuse me. That Mr. S neither valued or feels that he's effectively interpersonally cold or distant, but he views many of his behaviors this way and is distressed by it. So he has high interpersonal problems and distress. Similarly, with aloof, withdrawn behavior, he views himself as aloof and introverted, but he's also highly distressed about his avoidant behavior, but yet he also values that as a way of coping with some of the the difficulties he experiences in the social world. We move to the warm side of the circle. He values being warm and gregarious with others, but he sees himself as only average in warmth and markedly introverted. And neither of these qualities are considered strengths in his view of things. So enacting warm behaviors is also highly distressing for him. And the additional result, combined with also being sensitive to people's cold behaviors towards him, kind of ties together this picture of a man who desires connection. feels incapable of it and is attuned to others withdrawal but at the same time he's often withdrawn and cold himself and we think of reciprocity that tends to bring about others finding him standoffish and difficult to get get to know, often leading them to either pull away or generally not engage with him. And of additional interest, the dominant octant, which he showed that while his traits and strengths and values were relatively in line, he was actually distressed, interpersonal problems, distressed by being assertive and concerned that others found him domineering. And professionally, this led to him being ineffective at being assertive when he needed to be or could. when it was necessary, and instead he would adopt what he called a helping stance when he wanted someone to do something, claiming he was just watching out for them to help them avoid making mistakes. Of course, his colleagues didn't find this attitude reasonable, they found it disingenuous, they would react negatively to it, they would read through him, and this would leave him feeling puzzled, rejected, misunderstood, frustrated. So I'm just giving you this briefcase example as a way of illustrating the power of using multiple measures, even though they're all dispositional in nature and they're all assessing levels of conscious self-description, they have immense power to sort of faithfully represent the interpersonal personality dynamics of the patient. And for Mr. S, this structural approach made tangible the very issues that he was struggling to talk about in therapy. And the data from the assessment was shared with him and it became a real touchstone that was often referred back to in the therapy. It served to catalyze Mr. S's ability to recognize his own dynamics and to begin to address them in and out of session. Just a quick example of personality dynamics. Gonna shift to temporal dynamics for the rest of the talk, some of the very newest things in the interpersonal paradigm. Right, so temporal dynamics involves things happening over time, I'll go quickly through this. Assessing moment-to-moment patterns. This has been something interpersonal theory and assessment has been interested in for a long time. Aiden Wright and I said the goal of interpersonal diagnosis of psychopathology is to identify the patterns of behavior that lead to disturbed interpersonal relations. One way we can do this that's very exciting has been developed by Pam Sadler and her colleagues. It's called the Joystick Approach to Coding Interpersonal Behavior. Bottom left is just a standard gaming joystick. You can buy it off the shelf. Pam and her colleagues have developed programs. that interface with that. You can have raters observe a target person. So there's the old Gloria and Carl Rogers up at the top left. And the raters focus on one person and simply move the joystick in this two- two-dimensional space, there's on the upper right, there's our agency and communion space. The computer samples the position of the joystick many times a second, and we're able to then get the kind of data stream that's presented on the bottom right, which is a time series of data. And then we can watch how, say, two different time series belonging to two people interacting at the same time are related to each other. So let me tell you a little bit about some of the neat results that have been found with this method. Kate Thomas published a very interesting study this year that actually did go back and look at those old Gloria films. Gloria with Ellis, Gloria with Pearls, Gloria with Rogers. The first thing I'm going to show you is what are called density plots. This is without the time in there. This is basically the summaries of what positions they were in throughout their therapy session, Ellis being typically dominant, as you see on the left, but a little bit more dominant. warm and we see complementarity. Gloria is being a little submissive, following his lead, staying at about the same level of warmth. Now, Pearls, of course, is a provocateur, so he's also dominant, a little less warm, but he doesn't get the same response as we know from Gloria. They get into a bit of a power struggle, she's not very happy with him, et cetera. And then Rogers, he's in his prototypical warm, supportive place. Gloria compliments him and is warm and a little bit agentic back. So this is just the data that comes without putting it into a time series. We can also put it into a time series. So here's a couple of moments of Gloria and Ellis over time. Gloria is in the black. Ellis is in the gray dots. The top panel is a time series for both of them, only coding dominance. And the bottom panel is only coding affiliation. And what we see are two time series that are entrained. The top one is phase shifted. The peaks and troughs are opposed. opposing each other. That's exactly what we expect from agentic complementarity. When one person is leading, the other person is following. The time series is quantified that way, and of course Ellis tends to spend most of his time up in the more dominant position. On the bottom series, it's also entrained, but they're in phase rather than out of phase, and so most of the peaks and troughs line up. That's communal complementarity. More warmth, more warmth, more coldness, more coldness. It does seem like over the period of time things are getting a less friendly, but nonetheless their communion is entrained. We could look at this in any kind of psychotherapy session we want. In fact, a different way of looking at this, Pam Sadler calls windows into sessions. We can break sessions down into particular... events where interpersonal processes changed and we can ask what was happening at that time. So in this time series, again, client-therapist affiliation happens to be on top, client-therapist dominance on the bottom. And if we look at event A, it appears to bring about some striking changes in affiliation. Affiliation starts to go down after event A and the patient's dominance starts to go up. So they're not feeling so good and they're trying to be in control. control. Then in event B, something happens where the patient's lowest levels of dominance, the biggest troughs where they go, okay, I'm going to follow the lead here. Something happened with event B. And then at event C, there seems to be an increase in affiliation again, and the therapist and client take turns kind of leading and following. So I think this is a great tool for things like psychotherapy research, psychotherapy training, and supervision, and we could really learn at the moment-to-moment level. what's going on in psychotherapy. I really like the kind of data we get from this. The last thing I want to show you is a different kind of temporal dynamics to wrap up. This has to do with ambulatory assessment of social interactions in daily life. So what do we see if we kind of expand it from one interaction happening in a room to what happens in people's lives as they go out there and have all their social interactions? This is really taking advantage of new technology that I've been using. Of course, we have now smart phones and all. all kinds of mobile devices that we can give to our patients and they just look like everybody else out there playing with their devices they're not going to stand out at all right So we know that retrospective reports of mood symptoms and behaviors can be inaccurate, right? If you ask somebody about their mood for the week, that often doesn't correlate very highly with the measures of their daily mood, right? So if instead we're able to use this mobile technology and get them to tell us what's happening all day long, we may actually have more generalizable and more accurate assessment of mood or symptoms or functioning that is happening in daily life settings. It just works like this. We have the smartphones. We have surveys that we put on the smartphones. We ask the patients to pop those surveys up and tell us something about their interpersonal functioning or their symptoms many times a day, sometimes for up to 21 days. Here's how we do it, right? This is screenshots of our Motorola razors. Our patients pop up an interaction survey. This means they've been interacting with someone and when it's over we ask them, how did you perceive the other person? Familiar dimensions, agency and communion, friendly distant. dominant, submissive. We ask them, how did you act on the same dimensions? Friendly, submissive, dominant, or friendly, distant, dominant, submissive. And then we can ask some questions about how did that interaction impact you, right? What was your mood after that interaction? Pleasant, unpleasant, right? How was your self-esteem after that interaction? How were your mental health symptoms? You can tailor this to whatever it is that's important for that particular therapy, right? So we use an event contingent reporting. That is, we tell the patient, we ask the patients, every time you have a social interaction during the day, pop up the survey and let us know what happened. How did you see them? What did you do? How did it make you feel? And we do this for 21 days. I'm going to just give you some data very quickly on a psychotherapy outpatient. He had a 21-day smartphone-based interpersonal assessment. His wife also participated. And we had 62% of the social interactions that he reported were with his wife. That was verified. And then we had a couple of other things that we did. verified by the electronic records from both of them. And I just wanna say, I've been saying this for a long time, for the last three years at SPA, patients really can do this. So we've done this kind of protocol for nine patients. On average, they give us, over three weeks, 126 social interactions to evaluate. So we have the same kind of time series data that we saw at the moment-to-moment level, agency on the top, communion on the bottom. Now it's all within the perception of the patient, how he perceived the other person, how he behaved with that other person. And very quickly you can recognize... the pattern. Right on the top, you've got an entrained time series with shifted phase. Peaks and troughs are opposing each other. There's some evidence of complementarity in all of his social interactions across 21 days of sampling. Communion on the bottom. you've got the entrained time series that's in phase, and you see the peaks and troughs are more lining up, so people tended to be more warm, he tended to be more warm, people tended to be more cold, he tended to be more cold, in the natural settings of his daily life. But we can break this down further for clinical decision making and treatment. So this is some really nice work that Mike Roach did, where he took this fellow's time series, and this top overall correlation tells us that perceiving dominance in others leads to more submissive behavior or vice versa. This is just agentic complementarity. That negative .54 says yes, there seems to be reciprocity oppositeness going on in terms of perceiving others' agency and my own agency. We could zoom in in a couple of ways. We found that that effect was stronger when he was interacting with his spouse than when he was interacting with others. But probably the most unique thing that Mike did is this graph on the left. The Xs represent social interactions where he he perceived himself to be more dominant than the other person. And the dots on the right are the social interactions over three weeks where he perceived the other person to be more dominant than him. And when we look at that, we see that he really only showed complementarity when he was in the dominant position, right, with a minus 0.46 correlation. All the social interactions he had where he perceived the other person to be more dominant, there's no relationship. That's a zero correlation between what he did, right? That's a flat line. So. So he had no necessary consistent pattern of cooperating with people who were more dominant than him. Now in some data that I don't show you, we also knew that this fellow through his 21 days tended to, when he saw people as being dominant, he also tended to see them as being hostile towards him. So he kind of linked people's control with hostility and that would lead to lower self-esteem after social interactions. So we take all this together and it might provide some clues as to why he has such a hard time. time being cooperative and it helps us think about targeting his therapy around how can he be more appropriately cooperative, appropriately submissive when it matters, and not experience other people's control as a hostile threat to his self-esteem. That's what we're going to focus on in therapy and we can even see if the therapy is working by giving him another burst of assessment six or eight weeks later and seeing if this pattern changes. Almost done. I just want to give you one glimpse into the future so I can tell you what I'm talking about. what I'm going to talk about next year in Brooklyn. We just finished a two-year NIA-funded study. that allowed us to take 140 community-dwelling adults and have them go in a period of 12 months go through three different 21-day bursts of phone assessment and what we get out of that is this graph where we have a data set now that has 64,112 social interactions reported, that's nested within 8,557 person days of data, that's nested again into 426 burst per second, and that's bursts of data and ultimately 150 persons. What this will allow us to do is to not only look at variability but also patterns of long-term change. And I don't have any other data analysis to show you on this, I'm going to save it for Brooklyn. But it's been an honor to talk to you and thank you very much.

The Lerner family made a very generous gift to the Society for Personality Assessment in honor of Paul and his devotion to the Society for Personality Assessment, which is why this session has been named the Paul Lerner Memorial Master Lecture. So, and it will be so named going forward from now on. So it is now my great pleasure to introduce Dr. Aaron Pincus, who is a professor of psychology at Pennsylvania State University. I can't possibly say... Enough about him and so I'm not gonna try but instead I'm gonna turn the introduction over to Chris Hopper So when I was in my first year in my doctoral program at Texas A&M, I was struggling to try to become a proficient researcher, to try to become a proficient clinician, to try to think about how those two things go together.

And I went to my advisor Les Mori's office and I sort of talked with him about these struggles. I said, what do you think? And he said, well, in his sort of wise, terse way, you could think about it this way, and he handed me a book.

And in the book was a chapter by Aaron on interpersonal theory and how it applies. in the clinic. And I read the chapter and all of a sudden I started to have an answer to the question of if I see a patient this way and the patient does this thing in a session, how can I have a model-based, evidence-based way of thinking about what I should do in response that's not an abstraction about how you take a manual to a patient in a diagnostic group but answers a much more molecular question about how you can use personality science to inform your interactions in the consulting room. That was a transformative experience for me reading that.

that chapter. So my reaction to that was I got to meet this guy. And so I learned that he was a former president of a small society called the Society for Interpersonal Theory and Research.

I bought a ticket to go to the meeting and I met him and that was the second transformative experience for me. I think it's appropriate, at least from my personal experience, that Aaron is giving the inaugural Lerner master lecture because, from my experience, I love Aaron for the same reasons that I love SBA and I think it's the same things that Lerner. who I never had the fortune to meet, really valued and brought to the society.

The first is generativity. So I look in the crowd and I see Oliver and students, all of whom are now leaders in the field, in practice and research, and certainly he's had that impact on me. The second is the science of personality. Aaron was trained by Jerry Wiggins, a giant in the field of personality science and clinical psychology, and he's had a career full of really impactful scientific work in personality psychology. But the third is the application of personality science to the consulting room, the thing that really impacted me initially.

So what I love about SPA is that we really bring those three things together. It's a very student supportive group who values personality science, clinical practice, and mostly how you put those three things together. And that's really the way that I. I see Aaron.

I'm sure that you'll see Aaron the same way as you watch him give his talk. Aaron? Well, thanks very much.

I'll let you know I understand I'm standing between you and lunch today, so we will make sure you get there on time. And I only hope to do at least half as good a job as Phoebe did yesterday. So I do want to thank us.

for asking me to do this master lecture. I'm really honored to give the Paul Lerner Memorial Master Lecture. Today I'm going to be talking to you about contemporary interpersonal assessment from personality dispositions to personality dynamics.

And I think this is a very apropos topic for the Paul Lerner Memorial Lecture, because Paul had a deep appreciation for the interpersonal context of personality assessment. And in his 2009 article honoring Paul, our own F. Barton Evans said that Paul Lerner is perhaps the most pure example of an interpersonal approach to personality assessment.

So I hope the things I'll talk to you about today can honor that. And before I get started, I have to thank... a large number of people.

I want to thank my mentors and my students and my former students and my collaborators. These are really my interpersonal super friends. And I wouldn't be here without the luck of having these people, these really amazing people, to work with and to learn from.

And I'm basically going to be presenting a lot of their work as examples today of the contemporary interpersonal paradigm. That was a fun slide to make, by the way. So, a little bit of history, of course.

These are what I would consider to be the founders of the interpersonal paradigm, most of whom you probably know and recognize. Harry Stack Sullivan, Tim Leary, Maury Lohr, Don Kiesler, Bob Carson, Lorna Ben-Jones, Jerry Wiggins and Len Horowitz and boy am I lucky I pretty much except for Sullivan and Leary met all of these folks and had some collaborations and has really impacted me positively. The stuff I'm going to talk about today really rests on the foundations of the work of these people spanning some six decades.

But what I want to do is kind of turn it forward and say what's happening right now in the field of interpersonal assessment. Also just thank the society. The interpersonal paradigm has been well represented at SPA over the years and both Jerry Wiggins and Lorna Benjamin are former Bruno Klopfer award winners. So this just feels right at home for me. I'll give you a quick outline of what I'm going to talk about today.

I'm going to outline the contemporaries. assumptions of interpersonal theory and assessment. And I'm going to talk a little bit about personality dispositions in terms of a concept called interpersonal pathoplasticity, which I'll explain downstream. And then shift to talking about personality dynamics, which are some of the most, I think, exciting advances in interpersonal theory. I'm going to talk about structural dynamics.

I'm going to talk about temporal dynamics on two different kinds of time scales, moment-to-moment interpersonal functioning and also assessing interpersonal function. functioning in daily life. So here we go. So let's just first orient ourselves through the contemporary assumptions of interpersonal theory and assessment.

All right. So I'm going to start with the first one, which is the idea of the theory of the universe. And I'm going to start with the idea Now, my view is it's been evolving and growing, and in 2013, Emily Ansell and I said, whether it's referred to as the interpersonal paradigm or the interpersonal system or the interpersonal tradition, this approach to personality and social functioning is evolving into a meta-theory for psychological science.

And the reason it is is it provides a very integrative nomological net that you can use to look at personality, personality assessment, psychopathology, and psychology. pathology, psychotherapy, and health in a completely integrative way. And it's been that kind of approach that I've taken through most of my career.

One of the reasons I think we can call this a meta-theory is its ability to integrate perspectives. So most personality theories and clinical theories certainly touch on and sometimes emphasize relational, social, interpersonal. context and the interpersonal tradition really can integrate these.

So just some examples that we've written about and touched on from the psychodynamic tradition. We might talk about things like Blatt's relatedness and self-definition. which is highly interpersonal, or Kernberg and Clarkin's transference and object relations approaches.

Attachment has been integrated with interpersonal theory. Lorna Benjamin and Lynn Horowitz did quite a bit of work looking at how the internal working models and adult attachment styles are, in fact, emphasizing interpersonal functioning. The pure interpersonal approach, the paradigm, may be more focused on the here and now.

Interpersonal transactions and relationships, great paper last year in JPD. by Chris Hopwood talked about that. I also love Clara Hill and her concept of therapeutic immediacy, which is really about an interpersonal exchange between the therapist and the client.

We also have social cognitive theories that focus on social interpersonal functioning. We have Ken Locke and Pam Sadler talking about the idea of interpersonal efficacies. We can talk about someone's expectancies, their efficacies, their interpersonal beliefs and in a really fabulous synthesis in the early 90s by Jeremy Safran who integrated cognitive theory and interpersonal theory and that was very influential on my thinking about things. There's evolutionary mandates about social functioning, interpersonal functioning, the benefits that one gets by having a social dominance orientation and recognizing the need to belong and in the 80s Bob Hogan would refer to that as getting ahead and getting along. And even Richard Depew has good evidence for neurotransmitter systems and neurobiological systems focusing on interpersonal functioning like agentic extroversion and affiliation.

So we can take all of these and have them inform looking at things through the interpersonal paradigm. time. At least that's how I do it.

So let's talk about the assumptions that will organize the work that I'll present today. So the first assumption comes straight from Sullivan, of course. The most important expressions of personality and psychopathology occur in a phenomenon involving more than one person.

So here's three interpersonal situations we all might be familiar with. On the left, we're having a good time chatting with friends. That looks like Chris and I if his hair was a little longer.

The middle one probably needs no explanation as to why that's an important interpersonal situation for personality development. And maybe on the right, something unfortunate happening on the playground, but also an important event to impact the person's sense of self and other. So, come on up. There we go. Emily Ansell and I have defined the interpersonal situation as the experience of a pattern of relating self with other that's associated with varying levels of anxiety or security in which learning takes place that influences the development of self-concept and social behavior.

So sort of a contemporary restatement of some very basic Sullivanian ideas. So that's the first assumption. The second assumption is one that I think is important to emphasize for people who might not be so familiar with the paradigm, and that has to do with clarifying the nature of the interpersonal and the intrapsychic world. What we really want to think of when we hear the term interpersonal interpersonal is that it's focusing theory on some fundamental phenomenon that are important to know about for personality development, organization, function, and pathology. But it's not referring to simply proximal behaviors between two people that we can observe.

That's not the only place that interpersonal situations occur. So they also occur not only with that observable behavior that's going on in the proximal moment, but also in perceptions, memories, mental representations, expectancies, and fantasies. So we have proximal interpersonal interactions, but we also have interpersonal situations in the mind.

And we can consider both of those to be interpersonal. And that's an important part of the process. of expanding the paradigm and integrating the paradigm. So it's not just a behavioral focus.

It's a focus on how we represent and think and feel about our relationships and our sense of self and other. The third assumption is how are we going to talk about the important facets of interpersonal functioning? And we do it through the constructs of agency and communion.

These come from Bacon, but developed further by Jerry Wiggins and many of the other people I showed you. If we use agency and communion as our fundamental constructs, and perhaps use them as two axes to create a two-dimensional space, what we... do is we create a conceptual map that can describe interpersonal situations and the sort of famous instantiation of that is the interpersonal circle, the Leary circle, or many other versions of that name and I'm going to show you several versions of that today. We use the interpersonal circle to describe, understand, and measure both normal and abnormal interpersonal dispositions and also interpersonal dynamics, and that's something we'll get to through the lecture today.

We can apply the interpersonal circle as a map not only to the objective description of observable behavior and interaction, say, between therapists and clients, but also to the interpersonal situations evoked in the mind through perception, memory, mental repression, expectancy, and fantasy. So I feel like I have this iconic interpersonal circle sort of in my brain, and I kind of organize my experience of the world many times through that lens. Can't help it. Now, as an interpersonalist, I like circles. So I want to digress for a minute and talk just about circles as organizing structures just for a moment before I get into details.

They say that nature may abhor vacuums, but it seems to like circles, as does human nature. And some examples of this... Here's the zodiac, perhaps organizing our vision of the heavens.

The Buddhist wheel of life, which hopefully we can hop off of at some point if we're working the program well. The color wheel. which has some empirical basis for the associations and placements of the colors as it goes around the positions of it.

So circles are very, very useful organizing structures, I think, in nature and in human life, but also in psychology. So we've also used a lot of circular structures in psychology. In the study of emotions, we have a two-dimensional circular model of affect and mood.

Some people refer to the axes as valence and arousal. Some people talk about the axes as being negative affectivity, positive affectivity, but it's still the same two-dimensional space and just a matter of preferred rotations. And we've even been able to show that you can map out that circle.

on facial expressions of emotion. So this is kind of a, not the, you know, interpersonal functioning is not the only place we use these. There's circular structures used in the psychology of vocational preferences, right?

We have the famous RAI-SEC vocational preference circle, which was based on the seminal work of Holland. And if you've been on a university campus or been to a university counseling center, you know, this gives rise to the rather famous. what color is my parachute vocational preference circle. So we do use this in a variety of different assessment kinds of situations.

But let's now return to the interpersonal circle itself. So back to agency and communion, we can look at the interpersonal circle in a very broad, sort of what we call a meta-construct way that says that it's organized at different levels of specificity and functioning. So, of course, the y-axis here is the agentic axis, running from power mastery assertion at the top to passivity, weakness, failure, submission at the bottom. Communion is the x-axis.

which may run from intimacy, union, solidarity with others, to dissociation, a remoteness, a hostility, a disaffiliation from others, and that this can be understood as expressing things at various levels. So at the sort of broadest level, we might talk about interpersonal motives, and your motive might be to be in control, and because of that, you're going to express your disposition of dominance, and in the proximal moment, that might mean... having some directive behaviors that you enact.

Or you might have the motive to be close to others, expressing a disposition of nurturance, and then enacting a friendly behavior, something I seem to rarely do. Yes, that was a joke. But what I love about this is we can think about interpersonal functioning at so many different levels, and this is important.

To understand things clinically, I think. This is probably the most famous instantiation of the interpersonal circle. This is the interpersonal circle of traits and interpersonal problems.

So we go from agency and communion in that sort of broad way to the dispositions of dominance and nurturance. And each point around the circle is... a blend of these two fundamental dimensions.

So gregariousness, extroverted is a blend of being dominant and warm. Being unassuming and possibly exploitable is a blend of being warm but submissive. Being introverted is a blend of being is a blend of being submissive and cold, and being kind of arrogant or calculating or vindictive, that's a blend of being dominant and hostile, and dominant and cold.

So we can actually make as many fine-grained splits as we want in the circle, but the most common model tends to use these eight octants as a reliable way of measuring and assessing that. But we can find the circle in other places. I just wanted to show something that in 1996, Jerry Wiggins, his favorite cartoonist was William Stieg, the New Yorker cartoonist. And Jerry was able to find the same interpersonal structure in the corpus of William Stieg's New Yorker cartoons.

We call this the Stiegenplex. And I don't know that everyone can see it, so I'll just walk around it. At the top, most dominant, he says, I recreated myself.

In the hostile dominance, I know my rights. The cold-heartedness, I don't forget to be angry. Aloofness, people are no damn good.

Submissiveness, why pick on me? Sort of warm submissiveness. If you're good-natured, they'll step all over you.

Affiliation, a woman who can really love. And dominant, warm position, I can laugh at myself. So we really...

find the interpersonal system and the interpersonal circle in pretty much anything that has social implications including cartoons in the New Yorker. So that's my homage to Jerry. This was published in JPA by the way.

So we've now covered three contemporary assumptions. I have one more to go before we get into some fun stuff. My computer will forward.

There we go. The last one is, the last basic assumption is reciprocal influence. So the assumption is that interpersonal behavior doesn't happen in a vacuum, it doesn't happen randomly, that it creates reciprocal influences on interactants, and reciprocal patterns can be defined in the terms of the interpersonal circle based on agency and communion, dominance and nurturance. So here's a couple of reciprocal interactions.

Maybe on the left, there's some cold hostility kind of being met with a little bit of cold hostility. And on the right, there's some loving, getting some loving back. And these are just examples of how in the immediate moment, interpersonality behavior is having a reciprocal influence on what's going to happen next. We actually have a way of mapping that out according to the interpersonal model.

So let's figure that out really fast. We first think of interpersonal transaction cycles, this ongoing interactions between people, whether it's happening in your mind or it's happening proximally. In this case, I sort of put this slide, let's get into the consulting room, think about therapist and patient, and we can enter into that ongoing transaction at any point, but we'll just start with the patient having a covert reaction to whatever the therapist might have said or done, and that's now the patient's input to try to understand the moment, what's going on in the relationship.

following that. The patient's going to have some actual reaction based on their interpretation of it. That's the patient's output.

And the patient's output is immediately the therapist's input. Now the therapist has a reaction to what the patient has said or done and is trying to make sense of it along with the goals of what the therapy is aiming to do. And then the therapist makes a choice.

How do I respond to the patient? And this continues to cycle through over and over and over again as we watch a patient's reaction to the therapy. a relationship or an interaction develop.

And we now have ways of assessing the process of transaction cycles moving forward in time. And I'm gonna show you some examples of that later today. Now we can map these transaction cycles with reference to agency and communion. And we have a principle in the interpersonal paradigm called complementarity, which helps us map those transactions.

So there's our circle again. Complementarity is a set of principles that says we expect, in a probabilistic way, that there will be correspondence or sameness on nurturance, that warmth tends to beget or invite warmth back. Coldness tends to beget or invite coldness back, and what we call reciprocity or oppositeness on dominance, that a dominant act is an invitation to perhaps follow one's lead, and a more submissive act is an invitation to follow one's lead. to sort of take control, take the lead.

These are not basic just stimulus response cycles. There's a lot of stuff going on in the mind to get there, but we do have lots of empirical data that say this is kind of a common baseline in at least our Western culture's socialization. So part of it is about human development and child development.

So in the West, I think we are socialized to be relatively warm and friendly and to be sort of flexible as far as whether we're going to be taking the lead or following the lead. following the lead of someone else. And so that's sort of the common baseline of interpersonal functioning.

So that's what we want to think of it as, this kind of complimentary patterns. If Chris says something very warm to me, I'm gonna tend to be very warm back. This is the common baseline of these sort of field regulatory polls and invitations.

Jerry Wiggins wrote a great paper with Krista Tropst on the fields of interpersonal behavior and talking about these kinds of impacts. So again, it's not. not simple stimulus response, a lot of things go into maintaining a complementary pattern or not, but if you think of it as a common baseline, a sort of probabilistic expectation, then people who show chronic deviations from these complementary reciprocal patterns, they can't follow when someone offers to lead, they can't take the lead when someone needs it, they're not very warm to someone who's trying to be close to them, that maybe if this is chronic, these are indicators of some pathology, some abnormal functioning, something that needs to be addressed therapeutically.

At least in the culture I grew up in. So now I'm going to take those four assumptions, the interpersonal situation, the clarification of the interpersonal and the intrapsychic, our framework of agency and communion, and the idea of interpersonal influence and reciprocal influence, and I'm going to turn the rest of the talk to sort of showing you some of the most contemporary work that's going on in the interpersonal field by a lot of the people that I was thanking earlier today. So the first thing I'm going to do is talk about interpersonal dispositions.

I'm going to talk about the concept of interpersonal pathoplasticity, which I tend to promote as the idea of enhancing diagnosis with interpersonal dispositions. And the idea here is I know more as a clinician in my first session if I know both what my patient's diagnosis is and what their interpersonal characteristics are. And that might actually move the therapy forward more quickly than if I have to learn that without an assessment. And we... And we've been demonstrating a variety of ways in which there are relationships between personality and particularly in the interpersonal approach and psychopathology.

And one kind of personality psychopathology relationship that I know Tom Whitaker has written about is pathoplasticity. And that's actually where I learned about it first was from some of Tom's writing. So let me talk a little bit about what I mean by interpersonal pathoplasticity and show you some of the research that's been done. So we know what interpersonal dispositions are.

are. There are general tendencies, regularities, and relating self and other. My patient tends to be shy and withdrawn.

My patient tends to be chronically argumentative. My patient tends to be highly dependent. If we know these things interpersonally and we think about them through the lens of the interpersonal circle and all of its associated information, we can ask some very important therapeutic questions right away that are based on the more than the diagnostic label itself. What expectancies, schemas, fears, motives underlie my patient's behavior? What impact does the patient have on others or on the therapist?

How is the patient's behavior linked to their symptoms? These are things we study. How can I behave in ways that are going to facilitate a therapeutic alliance, even with, say, an argumentative, domineering kind of patient?

And how can I tailor treatments for optimal effectiveness? So I'm still trying to figure out how to do CBT with sort of argumentative, hostile, dominant patients, and this helps me figure out some ways to do that. So...

Interpersonal pathoplasticity is essentially combining the diagnosis with the interpersonal style to sort of jumpstart your clinical work with a patient. And, of course, there should be empirical evidence for this. So in this model, the symptoms, typically we used to call it Axis I. We don't call it Axis I anymore.

But the symptoms are contextualized within the personality. But there's some important relationships we need to be clear on. Usually using either cluster analytics. techniques or latent profile analytic techniques, there are interpersonal subtypes identified. We usually give some measure of the interpersonal circle to the patients, a group of patients, and through these agglomerative techniques, we find these subtypes within the same presumably homogeneous diagnostic clinical samples.

And important kinds of aspects to clarify a pathoplastic relationship from other kinds of personality psychopathology relationships are that typically we find no differences. in these subtypes, these interpersonal subtypes, no differences on symptom severity at the time of diagnosis. So it's not severity that's sort of driving the interpersonal subtypes. We find very few differences on diagnostic comorbidities.

So it's not different comorbidities that are driving these different subtypes. So they're non-eteological relationships. They're not causal, but having a certain interpersonal style in combination with a certain diagnosis does not mean does seem to impact the presentation of the disorder, the course of the disorder, the treatment response, and of course has those implications for forming the alliance and for tailoring your treatment. So I wanna do today, right now, is sort of show you some of the more recent research on pathoplasticity that have been published lately. All right, so we've done this, and other colleagues have done this, several of them are here today, so I hope I do justice to it.

We found interpersonal subtypes of the pathoplastic nature in generalized anxiety disorder, in social phobia, in major depression, in post-traumatic stress disorder, bulimia, and some other diagnoses. And what I'm going to do today is just let me review some of what we've learned so far using this approach. The first one I'm going to talk about is generalized anxiety disorder.

I have probably the most to do with this one. And this all started when a colleague of mine, Tom Borkovic, who's a well-known cognitive behavioral therapist for anxiety and for many years at Penn State, was one at work. was running RCTs for his cognitive behavioral treatments of GAD, and he asked me, how could I better predict who's going to attrit from my RCTs? And I said, I think we should assess their personalities. That's going to predict something, and suggested we...

We used the IIP, which is one of our measures of the circle. And it did turn out that the more cold GADs are the ones who had TRIT. We sort of had predicted that.

But we also found that there was actually more subtypes to look at. So this is what we found in two well-diagnosed clinical samples of GAD. So according to the DSM-IV, these patients are the same. They all meet criterion for the diagnosis, GAD. They all have uncontrollable worry.

they meet all of those kinds of symptom criterion. We find four groups in two different clinical samples that really replicated quite well. In each quadrant of the circle, an intrusive group, an exploitable group, a non-assertive group, and a cold group.

And each type has the same core uncontrollable worry that defines GAD, but when we ask them what they worry about, we find they worry about different things. So... So the exploitable, warm, submissive GADs tend to worry about, do you like me?

Are we okay? Is there anything wrong between us? Did I offend you in some way?

And the non-assertive GADs tend to worry about, can I do it? Will there be help available for me? Will someone be there if I need them?

The cold GADs are kind of concerned, are you going to hurt me? Are you going to take something away from me? And interestingly, the intrusive GADs, their number one worry tended to be, to be punctuality, like I'm concerned whether I'm going to get to the party on time. They were concerned about things like that.

Another way I tend to try to describe what the kind of implications of this are is, so what will happen is someone like the warm, submissive, exploitable GAD is going to get quite anxious if you break a date with them. Cold GADs are going to get quite anxious if you make a date with them. It tends to tell you what you really need to know. We also know that the more submissive subtypes of these groups, the more exploitable and non-assertives, do better in standard CBT treatment for GADs.

This is mainly learning anxiety management skills and things like that. At both end of treatment and at six-month follow-up, they're maintaining their gains and doing better than the two agentic subtypes. And we've talked about whether that's possibly some difficulties with the role relationship in cognitive behavioral therapy and who's going to be the expert and who's going to be the learner. So these submissive types tend to carry the benefits of CBT out further.

Another anxiety disorder study, Nicole Kane and colleagues looked at social phobia and found two subtypes that of course look similar in space to two of the GAD subtypes and I think they may have similar fears and anxieties. socially. But interestingly, no agentic subtypes.

And I like to point out this to show you that if you use this kind of technique with the circle and LPA or cluster analysis, you're not just guaranteeing you're going to find four subtypes every time because there's, say, four quadrants in the circle. It really depends, as you'll see, on the psychopathology you're studying. And these folks went through not a very, they didn't go through an RCT for treatment.

They kind of went through any kind of treatment as usual within their clinic in Europe that they thought was appropriate for the patients. And what we did find in this study was that the warm submissive sociophobics did better. And at the end of treatment, they were functioning better socially and personally, and they had better self-esteem and all the things that we like therapy.

to help our patients acquire, they were doing better than the non-assertives. And this actually replicates some work from about 20 years ago from an old mentor of mine, Lynn Alden, who did this with avoidant personality disorder and found, again, two similar types, and found that the warmer type of avoidant PD did better in treatment than the colder type. Nicole Keynes and her colleagues have also looked at it in terms of major depression.

And this is using, I think, data from the CLIP sample. And they found some very interesting results. So now we find... all diagnosed with major depression, all meeting criterion at the point of diagnosis.

So DSM is saying they're all homogeneous in terms of their mood disorder, but we actually find, or she actually found, six different interpersonal subtypes that. that again don't differ on severity, modest comorbidities. And they found some very interesting results about the long term chronicity and functioning. So in this study, after controlling for some PD diagnoses, what Nicole found and her colleagues found was that the submissive GADs, the ones that sort of lack agency and maybe they're also a little cold, relatively speaking, given their position at the bottom there in the green, that they follow up on 10 years of chronicity and function. And this submissive group spent over 177 weeks over 10 years with a rating of 5 or 6 on depression on the psychiatric status rating scale.

And they also had poor functioning having over 52 weeks with a GAF rating under 70. And that's compared for instance to the dominant and extroverted groups who tended to have about one third as many weeks with these kinds of symptoms. kinds of ratings over 10 years. So there's something about the lack of agency and maybe the lack of communion that's sort of impacting how the person's functioning with their depression over the course of 10 years.

It also means you can be extroverted and depressed, though, so that's something that you can take away from that, too. In a very recent study, also looking at chronicity and functioning, Kate Thomas and colleagues looked at the same kind of approach with PTSD. And here they found four groups, basic quadrants, warm dominant, cold dominant, warm submissive, cold submissive.

And the cold submissive PTSD group, again, that bottom green one, showed again the worst chronicity over 10 years, spending nearly 500 weeks at least meeting partial diagnosis for PTSD after 10 years. That means literally over the entire 10-year period, they continued to meet at least partial diagnosis for PTSD. Compared to the warm dominant and the cold dominant, the agentic groups, which had less than half of that. that time.

spent meeting at least partial diagnosis. So they seem to be resolving more quickly and having better functioning and less chronicity. Now, in summary, what we might take away from these examples is that cold, submissive interpersonal styles, that sort of lack of agency, lack of communion, impact depression, PTSD, and social phobia negatively. But remember, the agentic GAD patients actually didn't do so well at the end of CBT.

It was the submissive GADs that were doing better than the agentic ones. So it's not just one rule across the board. But I think... what's important to note there is it was only those GAD patients that went through a highly controlled RCT therapy outcome study and that the others were having a sort of more therapy as usual or different kinds of therapies so I think the next step we want to take in figuring this out is to start looking at some subtype by treatment interactions to see if we can understand which treatments are going to be tailored well for which kinds of patients so then again I can do that thing where I know my patient is GAD, but I also know what their interpersonal style is, and I can have a better sense of how to move the therapy forward quickly. So that's my talk on dispositions today.

That's all the stuff I'm going to say about dispositions today because I really want to spend the rest of the time today shifting gears and talking about assessing personality dynamics, which to me is the newest stuff in the interpersonal paradigm. So the first kind of dynamics I'm going to talk about is structural dynamics. And this comes from psychodynamic ideas that there are conflicts and balances in the processes and functions of the mind.

And we're thinking about the personality dynamics of the individual. And in the interpersonal tradition in the 50s, Tim Leary actually proposed that there were five levels of interpersonal conceptualization that you could think of in the person. Now we don't use in the contemporary paradigm Leary's actual levels, but instead we now have several different measures of interpersonal constructs that all conform to the agency and communion system. They all have the same structure, but they measure different specific interpersonal constructs. And we can use multiple surfaces, multiple assessment instruments to get at sort of what are balances and conflicts within the individual's personality.

And I'm going to give you an example of that today using a multi-surface interpersonal assessment. To do that, let me just introduce some of you who may not be familiar with the different surfaces you could choose to develop an assessment battery for your patient. All right. So we have several of these that can be used as self- reports, informant reports, they're all well validated, they all conform to the structure of the interpersonal circle.

Of course a famous one, general traits, Wiggins interpersonal adjective scales, assesses general interpersonal style. We have Kenlock's circumplex scales of interpersonal motives, or sorry, interpersonal values, which rates the importance of various interpersonal experiences for the person around the circle, so some people say it's really important that I'm seen as income- control and strong and agentic and others say it's really important that I'm seen as warm and supportive so on and so forth they rate how important the various interpersonal behaviors are for them efficacies are what they of course sound like develop again by Ken Locke and Pam Sandler how confident are you that you can enact various interpersonal behaviors that are mapped around the circle can you be dominant when you need to be can you be cooperative when you need to be can you be loving when you need to be etc Don Kiesler developed an interesting measure called the impact message inventory. This is actually used where the rater describes their own reactions to the target.

So how does interacting with that target person actually make me feel? What does it make me think about? What do I think is going on there?

All conforming to the interpersonal circle model. There's several others. Probably the most well-known in the clinical assessment is the inventory of interpersonal problems.

And this really assesses distressing interpersonal extremes and inhibitions. The measure says it's hard for me to do certain interpersonal things, or I do certain interpersonal things too much and I'm distressed by this. There's a new measure out that Chris Hopwood and colleagues developed that I really like called the interpersonal sensitivities circumplex. This assesses interpersonal behaviors that you say others do that bother you. So this is a really new idea but it actually conforms very well to the interpersonal.

circle. And we have the inventory of interpersonal strengths, which describes sort of highly adaptive interpersonal features around the entire circle. So even they were working very hard to say there are ways to be adaptively cold and distant. when you need to be in order to make sure you can be separate when you need to and still be able to connect when you need to.

So what I'm going to do now is I'm going to present a case, and I owe a lot of the material here to Aidan Wright. because I really want to give you the clinical flavor of this, I'm going to do a little bit more reading now to present to you a case where we used a multi-surface interpersonal assessment and I'll walk you through this case and give you a lot of clinical details. the slide in a minute, but I've got to introduce the patient and the therapy for you first. So I apologize to read. I don't want to miss it.

So this is a case of Mr. S. Mr. S was enrolled in a prestigious and competitive graduate engineering program. And to those that knew him, he was, and by his own admission, he was bright and had various intellectual interests, but he was socially awkward with few close friendships. However, in therapy he had started dating a younger undergraduate woman, and this was was his first real romantic relationship, first serious relationship. Now diagnostically, the majority of his complaints were well captured by DSM-5 diagnoses of major depressive disorder, recurrent, moderate, without psychotic features, and narcissistic personality disorder. And he was being seen for twice weekly transference-focused psychotherapy that was mainly focusing on his personality pathology.

Some of the features of narcissism that were really predominant in the... case. He had overvalued ideals and expectations for himself and others. He had an exquisitely experienced shame when things weren't going the way he hoped they would go. He had a ruminative focus on how others had wronged him and had accompanying rage over that.

He was devaluing of many people and things, including his advisor and the program he was in and his lab mates and others. he would protectively withdraw when things were not going well. He would kind of check out. And all of this left him quite vulnerable to experiencing intense bouts of suicidal depression.

And although he had been in psychotherapy for over two years, he and his new therapist, he had just started a transfer to a new therapist a couple of months before the assessment. And it was this transfer that kind of led to the idea of an assessment to jumpstart that new segment of therapy. And this was largely motivated by Mr. S's consistent pattern of stating that he didn't feel there was anything to say in sessions. And a review of the case notes suggested that this pattern was presaged. It had occurred with the previous therapist.

And it was successfully but slowly addressed through interpreting the subtle devaluation of saying, I have nothing to say when I come to therapy. and sort of implying therapy can't be helpful. So an alternative approach, an assessment approach was taken that was meant to bypass the sort of vulnerability this fellow felt with opening up in session and talking about himself. So what did we do?

We invited him to be collaborative about it, to ask his own questions about what the assessment might be able to reveal, and we decided on a multi-level battery. And the battery that we used... was a traits circle, a strength circle, a value circle, a sensitivity circle, and a problem circle, and these are his scores.

So what we can look at on these scores, and I'll show them to you in a couple of different ways, is if we think about his trait profile, profile, what it tells us, I know it's a little small for those of you in the back, but trust me. It was apparent from his trait profile that he viewed himself as prototypically withdrawn and aloof. That was his way of seeing himself generally. And in terms of interpersonal strengths, there were none.

That he felt he had excelled at no interpersonal behaviors, he felt generally ineffectual to some degree, everything on that. profile is below the T score of 50. It's all negative. His sensitivities profile was interesting because most of it was negative. It suggested he really wasn't bothered very much by other behaviors, by others' behaviors most of the time.

Didn't really care too much, wasn't negatively impacted with the one exception of when others maintained distance from him and withdrew from him. This is really what he was most sensitive to. In terms of his values for interpersonal functioning, he generally valued being warm and agreeable, which was decidedly in contrast to the characteristically aloof style that he attributed to himself.

And finally, when you think of his interpersonal problems profile, it was highly elevated, suggesting a lot of interpersonal distress, but it wasn't a particularly prototypical profile. There were peaks in some opposing places. scores included problems with being too warm and problems with being too aloof, which suggests some kind of conflict between how close and how distant he wanted to be in relation to others, because that's relatively opposite interpersonal conflict. context.

Now we can take these scores and put them up on a profile, map them, and see some discrepancies and some convergences that help us make interpersonal interpretations. So for example, we see that as far as being cold or having distance from people that... lost my place here for a second, excuse me.

That Mr. S neither valued or feels that he's effectively interpersonally cold or distant, but he views many of his behaviors this way and is distressed by it. So he has high interpersonal problems and distress. Similarly, with aloof, withdrawn behavior, he views himself as aloof and introverted, but he's also highly distressed about his avoidant behavior, but yet he also values that as a way of coping with some of the the difficulties he experiences in the social world.

We move to the warm side of the circle. He values being warm and gregarious with others, but he sees himself as only average in warmth and markedly introverted. And neither of these qualities are considered strengths in his view of things. So enacting warm behaviors is also highly distressing for him. And the additional result, combined with also being sensitive to people's cold behaviors towards him, kind of ties together this picture of a man who desires connection.

feels incapable of it and is attuned to others withdrawal but at the same time he's often withdrawn and cold himself and we think of reciprocity that tends to bring about others finding him standoffish and difficult to get get to know, often leading them to either pull away or generally not engage with him. And of additional interest, the dominant octant, which he showed that while his traits and strengths and values were relatively in line, he was actually distressed, interpersonal problems, distressed by being assertive and concerned that others found him domineering. And professionally, this led to him being ineffective at being assertive when he needed to be or could.

when it was necessary, and instead he would adopt what he called a helping stance when he wanted someone to do something, claiming he was just watching out for them to help them avoid making mistakes. Of course, his colleagues didn't find this attitude reasonable, they found it disingenuous, they would react negatively to it, they would read through him, and this would leave him feeling puzzled, rejected, misunderstood, frustrated. So I'm just giving you this briefcase example as a way of illustrating the power of using multiple measures, even though they're all dispositional in nature and they're all assessing levels of conscious self-description, they have immense power to sort of faithfully represent the interpersonal personality dynamics of the patient.

And for Mr. S, this structural approach made tangible the very issues that he was struggling to talk about in therapy. And the data from the assessment was shared with him and it became a real touchstone that was often referred back to in the therapy. It served to catalyze Mr. S's ability to recognize his own dynamics and to begin to address them in and out of session.

Just a quick example of personality dynamics. Gonna shift to temporal dynamics for the rest of the talk, some of the very newest things in the interpersonal paradigm. Right, so temporal dynamics involves things happening over time, I'll go quickly through this. Assessing moment-to-moment patterns.

This has been something interpersonal theory and assessment has been interested in for a long time. Aiden Wright and I said the goal of interpersonal diagnosis of psychopathology is to identify the patterns of behavior that lead to disturbed interpersonal relations. One way we can do this that's very exciting has been developed by Pam Sadler and her colleagues. It's called the Joystick Approach to Coding Interpersonal Behavior.

Bottom left is just a standard gaming joystick. You can buy it off the shelf. Pam and her colleagues have developed programs.

that interface with that. You can have raters observe a target person. So there's the old Gloria and Carl Rogers up at the top left. And the raters focus on one person and simply move the joystick in this two- two-dimensional space, there's on the upper right, there's our agency and communion space. The computer samples the position of the joystick many times a second, and we're able to then get the kind of data stream that's presented on the bottom right, which is a time series of data.

And then we can watch how, say, two different time series belonging to two people interacting at the same time are related to each other. So let me tell you a little bit about some of the neat results that have been found with this method. Kate Thomas published a very interesting study this year that actually did go back and look at those old Gloria films.

Gloria with Ellis, Gloria with Pearls, Gloria with Rogers. The first thing I'm going to show you is what are called density plots. This is without the time in there. This is basically the summaries of what positions they were in throughout their therapy session, Ellis being typically dominant, as you see on the left, but a little bit more dominant.

warm and we see complementarity. Gloria is being a little submissive, following his lead, staying at about the same level of warmth. Now, Pearls, of course, is a provocateur, so he's also dominant, a little less warm, but he doesn't get the same response as we know from Gloria.

They get into a bit of a power struggle, she's not very happy with him, et cetera. And then Rogers, he's in his prototypical warm, supportive place. Gloria compliments him and is warm and a little bit agentic back. So this is just the data that comes without putting it into a time series.

We can also put it into a time series. So here's a couple of moments of Gloria and Ellis over time. Gloria is in the black.

Ellis is in the gray dots. The top panel is a time series for both of them, only coding dominance. And the bottom panel is only coding affiliation. And what we see are two time series that are entrained. The top one is phase shifted.

The peaks and troughs are opposed. opposing each other. That's exactly what we expect from agentic complementarity.

When one person is leading, the other person is following. The time series is quantified that way, and of course Ellis tends to spend most of his time up in the more dominant position. On the bottom series, it's also entrained, but they're in phase rather than out of phase, and so most of the peaks and troughs line up.

That's communal complementarity. More warmth, more warmth, more coldness, more coldness. It does seem like over the period of time things are getting a less friendly, but nonetheless their communion is entrained.

We could look at this in any kind of psychotherapy session we want. In fact, a different way of looking at this, Pam Sadler calls windows into sessions. We can break sessions down into particular... events where interpersonal processes changed and we can ask what was happening at that time.

So in this time series, again, client-therapist affiliation happens to be on top, client-therapist dominance on the bottom. And if we look at event A, it appears to bring about some striking changes in affiliation. Affiliation starts to go down after event A and the patient's dominance starts to go up. So they're not feeling so good and they're trying to be in control.

control. Then in event B, something happens where the patient's lowest levels of dominance, the biggest troughs where they go, okay, I'm going to follow the lead here. Something happened with event B.

And then at event C, there seems to be an increase in affiliation again, and the therapist and client take turns kind of leading and following. So I think this is a great tool for things like psychotherapy research, psychotherapy training, and supervision, and we could really learn at the moment-to-moment level. what's going on in psychotherapy. I really like the kind of data we get from this. The last thing I want to show you is a different kind of temporal dynamics to wrap up.

This has to do with ambulatory assessment of social interactions in daily life. So what do we see if we kind of expand it from one interaction happening in a room to what happens in people's lives as they go out there and have all their social interactions? This is really taking advantage of new technology that I've been using. Of course, we have now smart phones and all. all kinds of mobile devices that we can give to our patients and they just look like everybody else out there playing with their devices they're not going to stand out at all right So we know that retrospective reports of mood symptoms and behaviors can be inaccurate, right?

If you ask somebody about their mood for the week, that often doesn't correlate very highly with the measures of their daily mood, right? So if instead we're able to use this mobile technology and get them to tell us what's happening all day long, we may actually have more generalizable and more accurate assessment of mood or symptoms or functioning that is happening in daily life settings. It just works like this.

We have the smartphones. We have surveys that we put on the smartphones. We ask the patients to pop those surveys up and tell us something about their interpersonal functioning or their symptoms many times a day, sometimes for up to 21 days. Here's how we do it, right? This is screenshots of our Motorola razors.

Our patients pop up an interaction survey. This means they've been interacting with someone and when it's over we ask them, how did you perceive the other person? Familiar dimensions, agency and communion, friendly distant.

dominant, submissive. We ask them, how did you act on the same dimensions? Friendly, submissive, dominant, or friendly, distant, dominant, submissive.

And then we can ask some questions about how did that interaction impact you, right? What was your mood after that interaction? Pleasant, unpleasant, right? How was your self-esteem after that interaction? How were your mental health symptoms?

You can tailor this to whatever it is that's important for that particular therapy, right? So we use an event contingent reporting. That is, we tell the patient, we ask the patients, every time you have a social interaction during the day, pop up the survey and let us know what happened. How did you see them? What did you do?

How did it make you feel? And we do this for 21 days. I'm going to just give you some data very quickly on a psychotherapy outpatient. He had a 21-day smartphone-based interpersonal assessment. His wife also participated.

And we had 62% of the social interactions that he reported were with his wife. That was verified. And then we had a couple of other things that we did. verified by the electronic records from both of them. And I just wanna say, I've been saying this for a long time, for the last three years at SPA, patients really can do this.

So we've done this kind of protocol for nine patients. On average, they give us, over three weeks, 126 social interactions to evaluate. So we have the same kind of time series data that we saw at the moment-to-moment level, agency on the top, communion on the bottom.

Now it's all within the perception of the patient, how he perceived the other person, how he behaved with that other person. And very quickly you can recognize... the pattern. Right on the top, you've got an entrained time series with shifted phase. Peaks and troughs are opposing each other.

There's some evidence of complementarity in all of his social interactions across 21 days of sampling. Communion on the bottom. you've got the entrained time series that's in phase, and you see the peaks and troughs are more lining up, so people tended to be more warm, he tended to be more warm, people tended to be more cold, he tended to be more cold, in the natural settings of his daily life. But we can break this down further for clinical decision making and treatment.

So this is some really nice work that Mike Roach did, where he took this fellow's time series, and this top overall correlation tells us that perceiving dominance in others leads to more submissive behavior or vice versa. This is just agentic complementarity. That negative .54 says yes, there seems to be reciprocity oppositeness going on in terms of perceiving others' agency and my own agency. We could zoom in in a couple of ways. We found that that effect was stronger when he was interacting with his spouse than when he was interacting with others.

But probably the most unique thing that Mike did is this graph on the left. The Xs represent social interactions where he he perceived himself to be more dominant than the other person. And the dots on the right are the social interactions over three weeks where he perceived the other person to be more dominant than him. And when we look at that, we see that he really only showed complementarity when he was in the dominant position, right, with a minus 0.46 correlation. All the social interactions he had where he perceived the other person to be more dominant, there's no relationship.

That's a zero correlation between what he did, right? That's a flat line. So.

So he had no necessary consistent pattern of cooperating with people who were more dominant than him. Now in some data that I don't show you, we also knew that this fellow through his 21 days tended to, when he saw people as being dominant, he also tended to see them as being hostile towards him. So he kind of linked people's control with hostility and that would lead to lower self-esteem after social interactions. So we take all this together and it might provide some clues as to why he has such a hard time.

time being cooperative and it helps us think about targeting his therapy around how can he be more appropriately cooperative, appropriately submissive when it matters, and not experience other people's control as a hostile threat to his self-esteem. That's what we're going to focus on in therapy and we can even see if the therapy is working by giving him another burst of assessment six or eight weeks later and seeing if this pattern changes. Almost done.

I just want to give you one glimpse into the future so I can tell you what I'm talking about. what I'm going to talk about next year in Brooklyn. We just finished a two-year NIA-funded study.

that allowed us to take 140 community-dwelling adults and have them go in a period of 12 months go through three different 21-day bursts of phone assessment and what we get out of that is this graph where we have a data set now that has 64,112 social interactions reported, that's nested within 8,557 person days of data, that's nested again into 426 burst per second, and that's bursts of data and ultimately 150 persons. What this will allow us to do is to not only look at variability but also patterns of long-term change. And I don't have any other data analysis to show you on this, I'm going to save it for Brooklyn. But it's been an honor to talk to you and thank you very much.

Transcript for:Honoring Paul Lerner's Legacy in Psychology

Transcript for:
Honoring Paul Lerner's Legacy in Psychology