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The developmental profile: Validation of a theory-driven instrument forpersonality assessmentMarike Polak a; Henricus L. Van b; Joanneke Overeem-Seldenrijk c; Willem J. Heiser a; Robert E.Abraham d

a Psychometrics and Research Methodology, University of Leiden, Leiden b Mentrum Mental HealthHospital, Amsterdam c J&S Consultancy, Leiden d Clinical Psychiatry and Psychotherapy, LeidenUniversity Medical Centre, Leiden, the Netherlands

First published on: 25 November 2009

To cite this Article Polak, Marike, Van, Henricus L., Overeem-Seldenrijk, Joanneke, Heiser, Willem J. and Abraham,Robert E.(2009) 'The developmental profile: Validation of a theory-driven instrument for personality assessment',Psychotherapy Research,, First published on: 25 November 2009 (iFirst)To link to this Article: DOI: 10.1080/10503300903352701URL: http://dx.doi.org/10.1080/10503300903352701

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The developmental profile: Validation of a theory-driven instrumentfor personality assessment

MARIKE POLAK1, HENRICUS L. VAN2, JOANNEKE OVEREEM-SELDENRIJK3,

WILLEM J. HEISER1, & ROBERT E. ABRAHAM4

1Psychometrics and Research Methodology, University of Leiden, Leiden; 2Mentrum Mental Health Hospital, Amsterdam;3J&S Consultancy, Leiden & 4Emeritus Professor, Clinical Psychiatry and Psychotherapy, Leiden University Medical Centre,

Leiden, the Netherlands

(Received 22 December 2008; Revision received 16 September 2009; accepted 20 September 2009)

AbstractThe Developmental Profile is an instrument for personality assessment. It covers both maladaptive and adaptivecharacteristics. The current study examined its internal consistency and construct validity in a Dutch sample of 763participants from various clinical and nonclinical settings. The internal consistency reliability estimates were good for theclusters of levels (adaptive, neurotic, and primitive), although not for all separate levels. Confirmatory factor analysisshowed an overall good fit, with the exception of the level of primary narcissism. Furthermore, empirical evidence was foundfor the interpretation of a patient’s Developmental Profile according to increasing levels of aggregation, with as a highestlevel a single maladaptivity�adaptivity scale score. This scale significantly distinguished among different patient groups.

Keywords: psychoanalytic/psychodynamic therapy; personality disorders; statistical methodology; personality

assessment; empirical validation

Personality pathology is generally regarded as one of

the most relevant clinical predictors of the course and

outcome of psychotherapy. The Diagnostic and Sta-

tistical Manual of Mental Disorders (fourth edition

[DSM-IV]; American Psychiatric Association, 1994)

Axis II is still the standard to classify personality

pathology, although from both a scientific and

clinical point of view it is strongly criticized (Widiger,

Simonson, Sirovatka, & Regier, 2006). Among other

things, the categorical classification, the heterogene-

ity within diagnosis, and the absence of defining

normal personality functioning limit its value. Never-

theless, for various personality disorders according to

DSM-IV, psychotherapeutic approaches have been

developed (e.g., Clarkin, Kenneth, Lenzenweger, &

Kernberg, 2007; Giesen-Bloo et al., 2006; Svartberg,

Stiles, & Seltzer, 2004).

However, at the level of case formulation or

planning specific psychotherapeutic strategies, the

utility of Axis II diagnosis can be questioned

(Verheul, 2005), in part, because it does not

operationalize systematically useful clinical concepts

such as interpersonal functioning, coping with stres-

sors, and self-image.

Psychodynamic concepts, although less scientifi-

cally elaborated and rather difficult to measure, are

considered as more closely related to the way clinic-

ians think about patients and to theoretical concepts

that are frequently applied in the psychotherapeutic

practice to understand patients.

A central and distinctive feature of the psychody-

namic approach is to adopt a developmental per-

spective on personality. This implies that personality

grows during life, alongside a line of increasing

maturity. It recognizes that the intrapsychic and

relational level of functioning in an individual are

ultimately determined by the interplay of immature

and mature characteristics. Therefore, both patho-

logical and healthy features of personality need to be

determined in order to obtain a balanced view on the

structure of personality and its role in the therapeutic

process.

An example of such a theoretically and clinically

driven instrument for personality assessment, which

Correspondence concerning this article should be addressed to Marike Polak, Psychometrics and Research Methodology Group, Leiden

University Institute for Psychological Research, Wassenaarseweg 52, PO Box 9555, 230 RB Leiden, the Netherlands.

E-mail: polak@fsw.eur.nl

Psychotherapy Research

2009, 1�14, iFirst article

ISSN 1050-3307 print/ISSN 1468-4381 online # 2009 Society for Psychotherapy Research

DOI: 10.1080/10503300903352701

Downloaded By: [Polak, Marike] At: 10:23 25 November 2009

takes a hierarchically arranged view on personality, is

the Developmental Profile (DP; R. E. Abraham,

1993; R. E. Abraham, 2005; R. E. Abraham et al.,

2001). Aspects of the predictive value have been

studied and have yielded promising results:

for instance, the prediction of dropout during

clinical psychotherapy (Ingenhoven, Duivenvoorden,

Passchier, & van den Brink, 2009). Furthermore, Van

et al. (2008) and Van, Dekker, Peen, Abraham, and

Schoevers (2009) have demonstrated the predictive

value for outcome of psychotherapy for depression of

some separate developmental lines such as object

relations and problem-solving behavior. In addition,

the DP appeared to be useful in various clinical

settings for determining psychotherapeutic strategies

(Ingenhoven, 2005; Van Marle & Abraham, 2005).

The aim of the current study is to examine the

internal consistency reliability and the construct

validity of the DP. In particular, we seek to validate

the hierarchical structure of the DP, reflecting its

developmental perspective on personality.

Description of the DP

As a frame of reference, the DP uses nine develop-

mental levels and nine developmental lines (see

Appendices A and B).Together, the nine develop-

mental levels and the nine developmental lines form

a matrix of 81 personality characteristics, which

correspond to the items of the DP.

The DP represents an attempt to organize and

standardize psychodynamic personality diagnostics.

As such, the instrument builds on the work of Anna

Freud (1963), Loevinger and Wesseler (1970),

Bellak, Hurulch, and Gediman (1973), Kernberg

(1981), and Luborsky and Crits-Christoph (1990).

The concept of the developmental lines and the term

developmental profile is derived from the work of

Anna Freud (1963). Available descriptions of devel-

opmental stages of behavioral domains were inte-

grated in the DP. The developmental lines of

norms and cognitions correspond to the stages of

moral and cognitive development described by

Kohlberg (1981) and Piaget (1962), respectively.

The developmental levels in the profile matrix are

ordered according to the degree to which they are

associated with the severity of maladaptive psycho-

social functioning. The lowest two levels, Lack of

Structure and Fragmentation, refer to Kernberg’s

(1981) psychotic and borderline personality organi-

zation. The level of Egocentricity refers to narcissis-

tic problems as elaborated by Kohut (1971). The

next three levels*Symbiosis, Resistance, and Riv-

alry*represent the oral, the anal, and the phallic

characters as described by K. Abraham (1925). The

three adaptive levels*Individualization, Solidarity,

Generativity*are based on Erikson’s (1966) model

of adult development.

Clearly, these levels reflect a continuum of severity

from adaptive to very maladaptive levels of person-

ality functioning. The levels are divided into healthy,

neurotic, and primitive or borderline ranges of

personality (Psychodynamic Diagnostic Manual

[PDM] Task Force, 2006, p. 20ff). Neurotic levels

represent conflict pathology. The primitive level that

ranges from the border of neurotic to psychotic

conditions represents developmental deficits. In the

DP this has been operationalized as the primitive

cluster (Lack of Structure, Fragmentation, and

Egocentricity), the neurotic cluster (Symbiosis, Re-

sistance, and Rivalry), and the adaptive cluster

(Individuation, Solidarity, and Generativity).

The developmental levels are not mutually exclu-

sive (Wilson & Gedo, 1993) but indicate a tendency

of behavior. Therefore, at the item level maladaptive

behavior in one domain does not exclude adaptive

behavior in another domain. For instance, the

behavior of a brilliant manager who scores high on

Productivity (61) may also be characterized to a

significant degree by behavior on the Egocentricity

level. This is in accordance with the prevalence of

personality disorder characteristics in nonpatient

samples (Vaillant & Drake, 1985; Zimmerman &

Coryell, 1989). By registering both types of func-

tioning, the DP makes it possible to chart complex

and even contradictory human behavior.

The item definitions were based on clinically

relevant behavioral patterns available in the litera-

ture. Because these descriptions were rather hetero-

geneous, the following criteria were used for item

selection and definition: clinical significance; exis-

tence of a theoretical link with either adaptation or

maladaptation of the individual’s functioning, where

adaptation refers to age-appropriate capabilities; and

possibility to relate the behavior to a single develop-

mental level. This latter criterion excluded general

psychopathologic phenomena, such as anxiety or

depression.

Hypotheses

In the current study, we examine the internal

consistency reliability and construct validity of the

DP. This was operationalized in the following

hypotheses:

1. The levels and the clusters of levels have

sufficient internal consistency reliability.

2. Underlying the items of the Developmental

Profile is a correlated nine-factor model, with

each factor representing a level and each item

having a positive loading on its corresponding

2 M. Polak et al.

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level only. Furthermore, the levels can be

reduced to a three-factor model, which justifies

the aggregation of the nine-level scores into

three cluster scores.

3. Underlying the levels, a bipolar scale can be

formed, ranging from highly maladaptive to

highly adaptive. On this scale, the levels are

ordered according to their position in the

scoring form. Subsequently, the levels can be

grouped into three ordered clusters.

4. Various patient groups can be distinguished

according to these scale values, assuming that

forensic inpatients form the most maladaptive

group and the normal controls form the most

adaptive group. The inpatients and outpatients

are positioned in between, with the latter as the

more adaptive of the two.

Method

Interview and Registration Protocol

The Developmental Profile is scored following a

semi-structured interview, which takes two to four

hours, covering such domains as relationships,

school and work, reactions to stressful events, deal-

ing with needs, anxiety or anger, and inadequacy.

The DP manual (Abraham, 2005) provides de-

tailed definitions of items and anchor points for

scoring. Scoring the DP requires an introductory

course that takes about 15 hours. The interviewer

indicates the degree to which each of the personality

characteristics is present using a 4-point scale ran-

ging from 0 (not present) to 3 (very clearly present).

Subsequently, for each level, the sum of the 9

corresponding items is determined. These level

scores make up the patient’s Developmental Profile.

Previous studies by Van et al. (2000) and Van,

Polak, Abraham, Overeem-Seldenrijk, and Van

Keulen (2005) showed sufficient interrater reliability

for scoring the various levels of the DP (with,

respectively, quadratically weighted kappa [Cohen,

1968] values ranging from .53 to .84 [M�.70]; and

ranging from .60 to .79 [M�.67]).

In the current study we investigate the justification

of interpreting a patient’s Developmental Profile

according to increasing levels of aggregation. First,

the item scores (i.e., the manifest behavior described

in the registration protocol) may be summed up into

level scores, which indicate the degree of functioning

on each specific developmental level. Second, one

may combine the level scores into a single score on a

bipolar maladaptivity�adaptivity scale ranging from

maximal maladaptive functioning (Lack of Struc-

ture) to maximal adaptive functioning (Generativ-

ity), using a data analytic approach.

Furthermore, the level scores may be grouped into

three successive clusters. The first cluster, referred to

as the primitive cluster, consists of Lack of Struc-

ture, Fragmentation, and Egocentricity. The second

cluster, referred to as the neurotic cluster, consists of

Symbiosis, Resistance, and Rivalry. The third clus-

ter, referred to as the adaptive cluster, encompasses

Individuation, Solidarity, and Generativity.

Participants

For the purpose of this psychometric evaluation,

data were pooled of patients from various sites in the

Netherlands were the DP was administered for use

either in daily clinical practice or in research. The

pooled sample consisted of 763 patients: 27 forensic

inpatients (3.5%), 468 psychotherapeutic psy-

chotherapy inpatients and day treatment patients

(61.3%), 166 outpatients (21.8%), and 102 non-

psychiatric controls (13.4%). The sample consisted

of 484 women (63.4%; mean age, 31 years, SD�10.5), and 277 men (36.3%; mean age, 36 years,

SD�10.7). For 2 patients (0.3%) gender informa-

tion was missing.

Procedure

The DP was administered following a two-step

procedure: A therapist or psychologist conducted

the DP interview, which was rated afterward by an

external psychologist based on the written text. The

raters did not have additional information about the

patient (e.g., a clinical diagnosis) in order to prevent

any scoring bias. In total, 35 different therapists and

psychologists administered the interviews. Each of

these practitioners participated in the DP introduc-

tory course, which was discussed earlier.

Data Analysis

The internal consistency reliability (Hypothesis 1)

was determined using Cronbach’s (1951) a coeffi-

cient. Two analyses were completed to evaluate the

construct validity of the DP. First, the item structure

(Hypothesis 2) was studied using confirmatory

factor analysis (CFA). Because in the DP the levels

are regarded as cumulative (or unipolar) scales (level

scores are determined by summing the correspond-

ing item scores), which are theoretically related, a

correlated nine-factor model was estimated. How-

ever, CFA is not suited for investigating the ordered

structure of the levels (Hypothesis 3), because the

scale underlying the various levels is bipolar (or

substitutive). Therefore, the level scores are analyzed

with correspondence analysis (CA). CA is known to

represent bipolar or substitutive scales correctly

(Heiser, 1981), unlike factor analysis, which is suited

The developmental profile 3

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for the analysis of unipolar or cumulative scales (Van

Schuur & Kiers, 1994).

CFA was conducted using EQS 6.1 software

(Bentler, 2003). The usual goodness-of-fit indices

are reported, including the root-mean-square resi-

dual (RMR), the root-mean-square-error of approx-

imation (RMSEA), the goodness-of-fit index (GFI),

the Bentler�Bonnet normed fit index (NFI), the

comparative fit index (CFI), the chi-square, and the

chi-square divided by degrees of freedom in the

model (chi-square/df). General guidelines indicate

that for good model fit the RMR should be less than

0.10, the RMSEA less than 0.05, the GFI greater

than 0.95, the CFI and NFI greater than 0.90, the

chi-square nonsignificant, and chi-square/df less

than 2 (Kline, 1998). For the individual factor

loadings, we used a cutoff value of 9.30 as the

minimum level of practical significance (Kline,

1998), and a�.01 as the significance level for two-

tailed statistical tests (Stevens, 1996).

CA was performed in SPSS 14.0 and is part of the

categories module (Meulman & Heiser, 2004) of

SPSS. CA, also known as dual scaling (Nishisato,

1996), produces an optimally weighted combination

of patients’ scores, comparable to principal-

components analysis (see, e.g., in the field of

personality assessment Maraun, Slaney, & Jalava,

2005), although both techniques have slightly dif-

ferent terminology (e.g., in the context of CA,

instead of the term variance, the term inertia is used).

The aim of CA is to find an optimal graphical

representation of patients and developmental levels

both (in this study) in as few dimensions as possible,

which usually results in a two-dimensional plot. When

data are one-dimensional (Hypothesis 3), a two-

dimensional representation will show what is often

referred to as the arch effect, where the levels and

patients are ordered along an arch according to their

position on the scale (e.g., Greenacre, 1984, p. 227).

In that case, only the scores on the first dimension are

used as scale scores, because the second dimension is

an artifact as a result of the nonlinearity of the item

responses.

The scores resulting from CA can be standardized

in different ways depending on the focus of the

analysis. In the current study, the level scores were

standardized to have a mean of 0 and a variance of 1,

and each patient’ s score is computed as the

weighted average of his or her corresponding level

scores.

To cross-validate the CA solution, we performed

10 stratified random splits with the four patient

groups as strata. For each split, the correlation was

computed between the CA scale values in both

subsamples.

Twenty-seven patients (3.5%), who were outliers

in the solution as a result of a strongly atypical

response pattern, were eliminated from both CFA

and CA. As an exclusion criterion, a cutoff score of 6

on the Egocentricity level (20) was used. This group

is described separately in the Discussion section.

Results

Internal Consistency Reliability of the DP

Levels

Table I shows the internal consistency reliability.

Cronbach’s a coefficients for the clusters of levels

ranged from .69 to .79 (mdn, .78), indicating

sufficient reliability for the cluster scores. For the

separate levels, a coefficients ranged from .44 to .81

(mdn, .60), indicating good and reasonable reliability

for Egocentricity, Symbiosis, and Individuation le-

vels but unsatisfactory reliability for the remaining

levels.

Confirmatory Factor Analysis of the DP Item

Scores

Construct validity of the DP (Hypothesis 2) was

investigated with CFA following a two-step proce-

dure. First, a nine-factor model was tested on the

items scores, with each factor representing a level.

Each item was allowed to load on its corresponding

factor only, and factors were allowed to correlate.

Second, a three-factor model1 was tested on the

level scores to test the presumption that level scores

may be aggregated into three clusters (primitive,

neurotic, and adaptive). Table II shows the fit

statistics for these factor models. We first interpret

the nine-factor model, which was fitted on the

individual items.

Table I Internal Consistency Reliabilities for the Levels and

Clusters of Levels of the Developmental Profile (N�763)

Developmental level Cronbach’s a

Clusters

Adaptive .79

Neurotic .69

Primitive .78

Levels

Generativity (80) .48

Solidarity (70) .60

Individuation (60) .64

Rivalry (50) .53

Resistance (40) .44

Symbiosis (30) .69

Egocentricity (20) .81

Fragmentation (10) .60

Lack of Structure (00) .58

4 M. Polak et al.

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As can be seen in Table II, the nine-factor model

meets the criteria of RMR, RMSEA, NFI, and CFI.

The GFI criterion is not met by the model. The chi-

square depends on the sample size, and given our

large sample size and consequently high power, a

significant chi-square is not necessarily a sign of a

poor fit. As an alternative, the chi-square/df ratio is

computed as a relative measure of fit. Here, this ratio

indicates acceptable model fit.

Table III shows the standardized factor loadings

for the nine-factor model, where Factor 1 represents

the most maladaptive level, Lack of Structure;

Factor 2, Fragmentation; and so on through Factor

9, which represents Generativity.

Sixteen items (19.8%) had nonsignificant loadings

(a�.01). The final row in Table III shows the

percentage of items with a factor loading greater

than .30 for each factor. For most factors, the

majority of the items had a loading exceeding .30.

However, Factors 3, 5, and 9, representing Egocen-

tricity, Resistance, and Generativity, respectively,

had more poorly fitting items. For the latter two

levels, this is in agreement with the lower alpha

coefficients. Apparently, the items of these levels had

relatively low intercorrelations. Egocentricity (Factor

3) showed good reliability but appeared not to fit the

structural model of the DP very well. We elaborate

on the deviant position of Egocentricity in the

discussion.

Subsequently, the three-factor model that was

tested on the level scores, which showed an accep-

table (according to the chi-square/df ratio and the

RMSEA; cf. Browne & Cudeck, 1993) to good fit

according to the remaining indices. Table IV shows

the standardized factor loadings for the three-factor

model.

All loadings were significant (a�.01); only Rivalry

did not fit into the neurotic cluster adequately. An

explanation for this lack of fit could be that Rivalry

was also substantially correlated with Egocentricity

(r�.40, pB.001).

The primitive and neurotic clusters were positively

correlated (r�.44, pB.001). Each of these clusters

was negatively correlated with the adaptive cluster

(r��.45, pB.001, and r��.56, pB.001, respec-

tively).

Mean DP Levels Scores for Various Patient

Groups

The mean DP level scores and standard deviations

for the four patient groups are reported in Table V.

Differences between patient groups were tested with

independent-samples t tests (a�.01), and differ-

ences between level scores within each patient group

were tested with paired-samples t tests (a�.01).

Table V shows that the patient groups clearly have

distinct score patterns, which show a peak on a few

adjoining levels. For instance, for the group of

psychotherapy inpatients, the ‘‘peak levels’’ are

Symbiosis and Resistance (the means on both the

more maladaptive levels and the more adaptive levels

for this group are significantly lower). Furthermore,

these patients scored significantly higher on Sym-

biosis and Resistance than the other patient groups,

which scored highly on either more maladaptive or

more adaptive levels.

These score patterns of the different groups seem

to justify summarizing a patient’s DP into one score

indicating the global level of psychosocial function-

ing. CA is a technique that derives such a scale score

from a patient’s DP.

Correspondence Analysis of the DP Level

Scores

To further investigate whether there is a bipolar

dimension underlying the different levels, on which

both the levels and the patients can be ordered in

terms of the degree of (mal-) adaptive functioning,

CA was performed on the level scores of the 736

patients. Recall that CA results in scores for both

levels and patients.

The CA solution for the level scores in two

dimensions is displayed in Figure I. This solution

showed that the level scores lie in an arch-shaped

pattern, which is marked by the dashed parabola.

The CA solution accounted for 55% of the total

inertia (37.3% and 17.7% for Dimensions 1 and 2,

respectively).

The apparent arch effect in Figure I was inter-

preted as support for the theory that an underlying

maladaptivity�adaptivity scale exists. The first di-

mension reflected the theorized order of the levels.

Table II Confirmatory Factor Analysis Goodness-of-Fit Indices

Model x2 (df) x2/df RMR RMSEA GFI NFI CFI

Nine-factor solution for DP items 6687.5 (3123) 2.14 .020a .039a .807 .926a .959a

Three-factor solution for DP levels 149.5 (24) 6.23 .055a .084 .955a .999a .995a

Note. RMR, root-mean-square residual; RMSEA, root-mean-square-error of approximation; GFI, goodness-of-fit index; NFI, normed fit

index; CFI, comparative fit index.aIndicates good model fit.

The developmental profile 5

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Table III Standardized Factor Loadings of the Nine-Factor Model (N�736)

Item 1: Lack of Structure 2: Fragmentation 3: Egocentricity 4: Symbiosis 5: Resistance 6: Rivalry 7: Individuation 8: Solidarity 9: Generativity

1 .35a

2 .16a

3 .15

4 .67a

5 .49a

6 .21a

7 .51a

8 .39a

9 .31a

11 .47a

12 .35a

13 .34a

14 .59a

15 .44a

16 .24a

17 .66a

18 .36a

19 .18a

21 .08

22 .42a

23 .23a

24 .58a

25 .22

26 .39a

27 .23a

28 .30a

29 .19

31 .44a

32 .60a

33 .53a

34 .55a

35 .58a

36 .32a

37 .12a

38 .35a

39 .46a

41 .18a

42 .42a

43 .16a

44 .47a

45 .01

46 �.05

47 .29a

48 .54a

6M

.P

olak

etal.

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Table III (Continued)

Item 1: Lack of Structure 2: Fragmentation 3: Egocentricity 4: Symbiosis 5: Resistance 6: Rivalry 7: Individuation 8: Solidarity 9: Generativity

49 .24a

51 .59a

52 .24a

53 .48a

54 .26a

55 .44a

56 .18

57 .12

58 .34a

59 .42a

61 .65a

62 .30a

63 .36a

64 .46a

65 .72a

66 .14a

67 .34a

68 .50a

69 .09

71 .63a

72 .56a

73 .18

74 .37a

75 .65a

76 .30a

77 .21a

78 .28a

79 .15

81 .56a

82 .61a

83 .18

84 .44a

85 .18

86 �.03

87 .11

88 .49a

89 .12

Percent

loadings�.30

67 78 44 89 33 56 78 56 44

aSignificant factor loading, pB.01 (method�Maximum Likelihood, robust).

The

dev

elopm

enta

lprofile

7

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The second dimension contrasted the extremes of

this scale with the midpoint.

Cross-validation with 10 stratified random splits

showed that the scale values presented in Figure I

are sufficiently stable; the correlation between the

scale values of both subsamples for each split ranged

from .969 to .999 (M�.988) for the first dimension

and from .898 to .990 (M�.958) for the second

dimension.

Dimension 1 contrasted the maladaptive levels

Lack of Structure, Fragmentation, and Egocentricity

(with explained inertias of .49, .50, and .18, respec-

tively) with the adaptive levels Lack of Individuation,

Solidarity, and Generativity (with explained inertias

of .67, .55, and .40, respectively). The levels Sym-

biosis, Resistance, and Rivalry were located around

the midpoint of the first dimension (with explained

inertias of .19, .02, and .003, respectively).

The clustering of the developmental levels into

three ordered clusters is apparent in Figure I, which

was also supported by the three-factor model dis-

cussed previously. In three of all 10 cross-validations,

the positions of Fragmentation and Egocentricity on

the first dimension interchanged, which also applied

to Resistance and Rivalry.

Note that, in contrast to unipolar scales, bipolar

scales also include items on the midpoint of the

scale, which necessarily have low correlations with

the underlying dimension. Therefore, percentage-

explained inertia is not sufficient to judge the quality

of these types of scales (cf. Ter Braak & Verdonschot,

1995, p. 274). Alternative criteria (e.g., validation by

an external criterion) are often used. For this

purpose, we further analyzed the patients’ scale

values, which are discussed in the following.

Like the developmental levels, for each patient the

score on the first CA dimension is interpreted as a

score on the maladaptivity�adaptivity scale. Analysis

of variance of the CA scale scores between the

different patient groups revealed significant differ-

ences between the groups and a large effect size: F(3,

732)�245.10, pB.0001, h2�.50. Paired compar-

isons among subsequent groups with (Bonferroni

corrected) t tests showed that each group is sig-

nificantly different from the groups in closest proxi-

mity (forensic inpatients [M��1.11] vs.

psychotherapy inpatients [M��0.13], pB.0001;

psychotherapy inpatients vs. outpatients [M�0.21],

pB.0001; outpatients vs. normal controls [M�0.69], pB.0001). Note that, given the psychiatric

complaints in the groups of in- and outpatients, we

expected the first to be more maladaptive. These

results strongly confirmed the hypothesis that pa-

tient groups can be significantly distinguished and

Table IV Standardized Factor Loadings of the Three-Factor Model (N�736)

Developmental level I: Primitive cluster II: Neurotic cluster III: Adaptive cluster

Generativity (80) .64a

Solidarity (70) .73a

Individuation (60) .81a

Rivalry (50) .24a

Resistance (40) .48a

Symbiosis (30) .68a

Egocentricity (20) .44a

Fragmentation (10) .78a

Lack of Structure (00) .62a

aSignificant factor loading, p B.01 (method�Maximum Likelihood, robust).

Table V Mean Scores (Standard Deviations) of the Nine Developmental Levels for the Four Groups of Patientsa

Developmental level

Forensic inpatients

(n�27)

Psychotherapy inpatients

(n�468)

Outpatients

(n�166)

Normal controls

(n�102)

Generativity (80) 0.04 (0.19)a 0.31 (0.61)a .80 (1.32)b 1.61 (1.51)c

Solidarity (70) 0.22 (0.51)a 1.63 (1.71)q 2.82 (2.00)k 3.76 (2.71)f

Individuation (60) 1.11 (1.09)g 4.17 (2.17)h 5.95 (2.76)i 7.35 (2.73)j

Rivalry (50) 2.59 (1.93)kq 3.19 (2.52)k 2.88 (2.48)k 2.07 (1.80)c

Resistance (40) 3.96 (2.55)ks 7.40 (2.98)m 6.07 (2.60)i 4.06 (2.52)fk

Symbiosis (30) 4.81 (2.75)s 8.60 (3.79)o 6.48 (3.61)i 2.11 (1.77)c

Egocentricity (20) 2.26 (2.33)gq 0.84 (2.14)rt 0.49 (1.27)br 0.33 (1.56)r

Fragmentation (10) 2.74 (1.72)kq 1.71 (2.06)q 0.49 (1.12)br 0.11 (0.40)r

Lack of Structure (00) 5.30 (1.68)s 0.88 (1.46)t 0.36 (1.05)r 0.07 (0.38)r

Note. Means not sharing similar subscripts within each row and column differ at pB.01.aPossible score range per level: 0�27.

8 M. Polak et al.

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ordered by their scores on the bipolar scale under-

lying the DP. Furthermore, we found a significant

correlation of the bipolar scale underlying the

Developmental Profile with age (r�.36, pB.001,

N�706), indicating that developmental differences

in adults as measured by the DP are partly a natural

result of aging.

Discussion

This study investigated the internal consistency and

construct validity of the DP. The three clusters

(adaptive, neurotic, and primitive) all had a good

internal reliability, although for separate levels the

reliability appeared not to be satisfactory.

CFA showed an overall good fit, thereby providing

a justification for the organization of item scores into

level scores. Furthermore, the CFA results justify the

various levels as interrelated subscales, which can be

aggregated into three clusters, thus supporting con-

structs of a primitive maladaptive cluster (Lack of

Structure, Fragmentation, and Egocentricity), a

neurotic maladaptive cluster (Symbiosis, Resistance,

and Rivalry), and an adaptive cluster (Individuation,

Solidarity, and Generativity).

Taken together, these results can be considered

in line with psychoanalytic developmental theory.

This assumes levels of personality organization and

distinguishes healthy personality, neurotic level, and

borderline level (see, e.g., PDM Task Force, 2006).

Apparently, at the differentiated levels within a

cluster it is still more difficult to obtain sufficient

reliable scores. This may reflect a measure problem,

which could, for instance, be solved by a better

operationalization of items. Further studies on the

instrument have to be done with regard to this

matter.

Correspondence analysis showed a bipolar scale

underlying the Developmental Profile ranging from

maladaptive to adaptive psychosocial functioning

that significantly distinguished all different patient

groups. There was a significant relationship between

the scores on this scale and age. Cross-validations

showed good stability of the CA scale values.

These results confirm the usefulness of distin-

guishing adaptive levels. It also indicates its useful-

ness to operationalize adaptivity not only by the

absence of pathology but also by the presence of

specific adaptive characteristics. In addition, it

suggests that personality in general grows to further

maturity during life in adulthood. This is concordant

with the personality theory of Erikson, which was

taken as one of the underlying concepts for the DP.

It is also in line with literature reported findings with

regards to the development of defense mechanisms

(Vaillant, 1993, p. 134ff).

A subgroup of 27 patients (3.5% of the total

sample) was excluded from the CFA and CA (but

not from the reliability analysis). These patients were

characterized by a combination of high scores on

both Levels 20 and 50. This group was identified as

an outlier in the CA analysis, because in the two-

dimensional solution the group formed a remote

cluster. Inspection of the profile scores of this group

Figure I. Developmental level scale scores in two dimensions resulting from correspondence analysis (CA) of the profile scores. Numbers

refer to levels (see Appendixes A and B). On either side of each scale score, the respectively lowest and highest estimate of the first

dimension score resulting from cross-validation are depicted.

The developmental profile 9

Downloaded By: [Polak, Marike] At: 10:23 25 November 2009

showed that all patients had a score of 6 or higher on

Egocentricity (Level 20). This group had such an

outlying score pattern that in the EQS analysis it

caused a failure to converge. Thus, although the

reported reliabilities of the level and cluster scores do

apply to this group, the position of this group in the

hierarchy of the DP (in terms of adaptivity and

maladaptivity) is ambiguous.

Theoretically, this is an interesting finding. Ap-

parently, the order of the levels that follows from the

score patterns of all other patients does not apply to

this group. That is, this group combines high scores

on Egocentricity with high scores on Rivalry (Level

50). An explanation for the relatively high scores on

Rivalry for this maladaptive group may be found in

the concept of the so-called oblivious narcissism, as

described by Gabbard (2000). Persons with this type

of narcissism not only believe they are superior but

are also inclined to show this in strong competitive

behavior. In the DP this is represented in the

patterns of rivalry (see Appendixes A and B), thus

leading to a joint appearance of these two levels.

Limitations and Strengths

This study has a number of limitations. First, we

were not able to measure the interrater reliability of

the whole sample; therefore, the exact degree of

measurement error attributable to raters is un-

known. However, in earlier publications, interrater

reliability was reported (Van et al., 2000, 2005) of

subsamples that are included in this study. Also, all

raters were well trained, and their competency was

evaluated by one of the registered DP supervisors

before participating in the current study. In addition,

it was always possible for raters to discuss questions

or doubts with the one of the DP supervisors,

including two of the authors (Robert E. Abraham

and Henricus L. Van). We aimed to eliminate rater

variability as much as possible by using consensus

scores.

Second, we did not compare the DP scores with

regular diagnoses of the patient as made during their

intake procedure at the participating institutes and

departments. However, there was considerable varia-

bility in diagnostic procedures across institutes and

departments, in particular with regard to personality

pathology, which was by not measured with other

instruments in a comparable way. Therefore, we

thought it not to be useful to relate DP scores with

the clinical Axis II disorders.

Third, the unsatisfactory values of Cronbach’s acoefficient for most of the separate levels of the DP

imply that these levels (e.g., Generativity) should be

interpreted with caution when using the DP in

individual patients in clinical practice.

We used Cronbach’s a for the reliability analysis,

because it is the most common statistical analysis for

that purpose. However, there is discussion on which

values of alpha are desirable in the field of person-

ality measurement. For instance, Boyle, Stankov,

and Cattell (1995, p. 436) argue that low to

moderate item homogeneity is preferable, so that

each item contributes to the breadth of measurement

of a given scale. The authors refer to Kline (1986)

and Cattell (1982), who suggested reliabilities in the

range 0.3 to 0.7 on the basis that, to obtain

maximum validity, items do not need to correlate

highly with each other but rather with an external

criterion. Furthermore, the construction of the DP

as a matrix that fixes the number and nature of the

items of each scale limits the possibility to redefine

problematic items that were identified by the CFA.

Moreover, this prohibits the general approach to

improve the reliability of a scale, which is to include

more items (cf. Streiner, 2003).

A fourth limitation of this study is that, other

psychometric properties, such as test�retest reliabil-

ity, were not measured. Thus, the stability of the DP

scores over time is not known. Because most of the

DP interviews were administered before the start of

therapy in patients with a concurrent Axis I disorder

as well, one might question the extent to which this

has influenced the scores. On the other hand, in

earlier studies with the DP (Van et al., 2008, 2009),

an influence of severity of concurrent Axis I symp-

toms on the DP scores could not be demonstrated.

Apparently, the interview protocol that provides

specific instruction on how to minimize potential

influence of symptoms on the answers has been

adequate in this respect.

A strength of the study is the very large number of

patients included. It enabled us to perform in a more

reliable way statistical analysis that in smaller sam-

ples would not have been possible, such as a reliable

use of factor analysis and the cross-validation of the

correspondence analysis.

Second, the DP is a theory driven instrument that

makes use of concepts closely related to the way

clinicians think about patients. As such, it is an

attempt to bridge the gap between (a) personality

characteristics that may arise during a psychother-

apeutic process and need to be taken into account

and (b) research data. An example is provided in

Appendix B, which shows how the same behavior of

a patient could be placed on various levels of the DP,

depending on the context.

In conclusion, we believe the DP is a promising

instrument. Psychometric studies confirm the devel-

opmental perspective of personality, although there

is ongoing research to improve the internal consis-

tency reliability of some of the developmental levels

10 M. Polak et al.

Downloaded By: [Polak, Marike] At: 10:23 25 November 2009

that make up the DP. The DP summarizes in one

model a broad array of psychodynamic concepts that

have proven useful in daily psychotherapeutic prac-

tice. Further research in concordant and prognostic

validity is required and may reveal whether the

application of the DP in clinical practice can

improve selection of psychotherapeutic strategies

and interventions in an individual patient and

enhance treatment outcome.

Acknowledgements

This study was supported by a grant from the Dutch

Psychoanalytic Foundation. This foundation had no

involvement with the design and conduct of the

study; data collection, management, analysis, or

interpretation; and manuscript preparation, review,

or approval. We thank Harry Stroeken, PhD, for his

help in obtaining the participation of nonpsychiatric

volunteers.

Note1 An additional CFA was performed to test a three-factor model

using item-level data, which provided further support for the

three-cluster hypothesis. Interested readers can request the

complete CFA results from the corresponding author.

References

Abraham, K. (1925). Psychoanalytische Studien zur Characterbil-

dung (Psychoanalytic studies on personality development).

Wien, Germany: Internationaler Psychoanalytischen Verlag.

Abraham, R. E. (1993). The developmental profile: The psycho-

dynamic diagnosis of personality. Journal of Personality Dis-

orders, 7(2), 105�115.

Abraham, R. E. (2005). Het Ontwikkelingsprofiel, een psychody-

namische diagnose van de persoonlijkheid (The Developmental

Profile, a psychodynamic diagnosis of personality). In R. E.

Abraham (Ed.), The Developmental Profile (pp. 5�98). Assen, the

Netherlands: Van Gorcum.

Abraham, R. E., Van, H. L., van Foeken, I., Ingenhoven, T. J. M.,

Tremonti, W., Pieper de Vries, I., et al. (2001). The Develop-

mental Profile. Journal of Personality Disorders, 15(5), 457�473.

American Psychiatric Association. (1994). Diagnostic and statistical

manual of mental disorders (4th ed.). Washington, DC: Author.

Bellak, L., Hurvich, M., & Gediman, H. (1973). Ego functions in

schizophrenics, neurotics and normals. New York: Wiley.

Bentler, P. M. (2003). EQS 6.1 for Windows [Computer Soft-

ware] Encino, CA: Multivariate Software.

Boyle, G. J., Stankov, L., & Cattell, R. B. (1995). Measurement

and statistical models in the study of personality and intelli-

gence. In D. H. Saklofske & D. H. Zeidner (Eds.), International

handbook of personality and intelligence (pp. 417�446). London:

Plenum Press.

Browne, M. W., & Cudeck, R. (1993). Alternative ways of

assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing

structural equation models (pp. 136�162). Beverly Hills, CA:

Sage.

Cattell, R. B. (1982). The psychometry of objective motivation

measurement: A response to the critique of Cooper and Kline.

British Journal of Educational Psychology, 52, 234�241.

Clarkin, J. F., Kenneth, N. L., Lenzenweger, M. F., & Kernberg,

O. F. (2007). Evaluating three treatments for borderline

personality disorder: A multiwave study. American Journal of

Psychiatry, 164, 922�928.

Cohen, J. A. (1968). Weighted kappa: Nominal scale agreement

with provision for scaled disagreement or partial credit.

Psychological Bulletin, 70(4), 213�220.

Cronbach, L. J. (1951). Coefficient alpha and the internal

structure of tests. Psychometrika, 16, 297�334.

Erikson, E. H. (1966). Eight stages of man. International Journal of

Psychiatry, 2(3), 281�307.

Freud, A. (1963). The concept of developmental lines. The

Psychoanalytic Study of the Child, 18, 245�265.

Gabbard, G. O. (2000). Psychodynamic psychiatry in clinical

practice. Washington, DC: American Psychiatric Press Inc.

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W.,

Dirksen, C., van Asselt, T., et al. (2006). Outpatient psy-

chotherapy for borderline personality disorder: Randomized

trial of schema-focused therapy vs. transference-focused psy-

chotherapy. Archives of General Psychiatry, 63, 649�658.

Greenacre, M. J. (1984). Theory and applications of correspondence

analysis. New York: Academic Press.

Heiser, W. J. (1981). Unfolding analysis of proximity data. Unpub-

lished doctoral dissertation, Leiden University.

Ingenhoven, T. J. M. (2005). Het gebruik van het ontwikkeling-

sprofiel binnen de klinische en dagklinische psychotherapie

voor persoonlijkheidsstoornissen (The use of the DP in clinical

psychotherapy and outpatients’ treatment for personality dis-

orders). In R. E. Abraham (Ed.), The Developmental Profile (pp.

217�226). Assen, the Netherlands: Van Gorcum.

Ingenhoven, T. J. M., Duivenvoorden, H. J., Passchier J., & van

den Brink, W. (2009). Treatment duration and premature

termination of psychotherapy in personality disorders: Predic-

tive validity of the Developmental Profile assessing psychody-

namic personality diagnosis. In Ingenhoven, T. J. M., The role of

psychodynamic assessment in diagnosis and treatment of personality

disorders: Reliability and validity of the Developmental Profile.

Dissertation, Erasmus University Rotterdam (pp. 107�127).

Rotterdam, The Netherlands.

Kernberg, O. F. (1981). Structural interviewing. Psychiatric Clinics

of North America, 4, 169�195.

Kline, P. (1986). A handbook of test construction: Introduction to

psychometric design. London: Methuen.

Kline, R. B. (1998). Principles and practice of structural equation

modeling. New York: Guilford Press.

Kohlberg, L. (1981). The philosophy of moral development: Moral

stages and the idea of justice. San Francisco: Harper & Row.

Kohut, H. (1971). The analysis of the self. New York: International

Universities Press.

Loevinger, J., & Wesseler, R. (1970). Measuring ego development.

San Francisco: Jossey-Bass.

Luborsky, L., & Crits-Christoph, P. (1990). Understanding trans-

ference. The core conflictual relationship theme method. New York:

Basic Books.

Maraun, M. D., Slaney, K., & Jalava, J. (2005). Dual scaling for

the analysis of categorical data. Journal of Personality Assessment,

85(2), 209�217.

Meulman, J. J., & Heiser, W. J. (2004). SPSS Categories 13.0.

Chicago: SPSS Inc.

Nishisato, S. (1996). Gleaning in the field of dual scaling.

Psychometrika, 61, 559�599.

Piaget, J. (1962). The stages of the intellectual development of the

child. Bulletin of the Menninger Clinic, 26, 120�128.

Psychodynamic Diagnostic Manual Task Force. (2006). Psycho-

dynamic diagnostic manual. Silver Spring, MD: Alliance of

Psychoanalytic Organizations.

The developmental profile 11

Downloaded By: [Polak, Marike] At: 10:23 25 November 2009

Stevens, J. S. (1996). Applied multivariate statistics for the social

sciences (3rd ed). Mahwah, NJ: Erlbaum.

Streiner, D. L. (2003). Starting at the beginning: An introduction

to coefficient alpha and internal consistency. Journal of Person-

ality Assessment, 80, 99�103.

Svartberg, M., Stiles, T. C., & Seltzer, M. H. (2004). Rando-

mized, controlled trial of the effectiveness of short-term

dynamic psychotherapy and cognitive therapy for cluster C

personality disorders. American Journal of Psychiatry, 161, 810�817.

Ter Braak, C. J. F., & Verdonschot, P. F. M. (1995). Canonical

correspondence analysis and related multivariate methods in

aquatic ecology. Aquatic Sciences, 57, 255�289.

Vaillant, G. E. (1993). The wisdom of the ego. Cambridge, MA:

Harvard University Press.

Vaillant, G. E., & Drake, R. E. (1985). Maturity of ego defenses in

relation to DSM-axis II personality disorder. Archives of General

Psychiatry, 42(6), 597�601.

Van, H. L., Dekker, J., Peen, J., Abraham, R. A., & Schoevers,

R. A. (2009). Predictive value of self-reported and observer

rated defense style in depression treatment: An exploratory

study. American Journal of Psychotherapy, 63, 25�41.

Van, H. L., Hendriksen, M., Schoevers, R. A., Peen, J., Abraham,

R. A., & Dekker, J. (2008). Predictive value of object relations

for therapeutic alliance and outcome in psychotherapy for

depression: An exploratory study. Journal of Nervous and Mental

Disease, 196(9), 655�662.

Van, H. L., Ingenhoven, T. J. M., van Foeken, I., van ‘t Spijker,

A., Spinhoven, P., & Abraham, R. E. (2000). The Develop-

mental Profile: Preliminary results on interrater reliability and

construct validity. Journal of Personality Disorders, 14(4), 360�365.

Van, H. L., Polak, M. G., Abraham, R. E., Overeem-Seldenrijk, J.,

& van Keulen, A. (2005). De interbeoordelaarsbetrouwbaarheid

van het Ontwikkelingsprofiel (The interrater reliability of the

Developmental Profile). In R. E. Abraham (Ed.), The Develop-

mental Profile (pp. 267�274). Assen, the Netherlands: Van

Gorcum.

Van de Loo, E., & Abraham, R. E. (2005). Coaching en

consultatie; toepassingsmogelijkheden van het Ontwikkeling-

sprofiel (Coaching and consultation: The applicability of the

Developmental Profile). In R. E. Abraham (Ed.), The Develop-

mental Profile (pp. 229�238). Assen, the Netherlands: Van

Gorcum.

Van Marle, H., & Abraham, R. E. (2005). Dynamisch persoonlij-

kheidsonderzoek in de forensische psychiatrie: het Ontwikke-

lingsprofiel. (Dynamic personality assessment in forensic

reporting: The Developmental Profile). In R. E. Abraham

(Ed.), The Developmental Profile (pp. 241�252). Assen, the

Netherlands: Van Gorcum.

Van Schuur, W. H., & Kiers, H. A. L. (1994). Why factor analysis

is often the wrong model for analyzing bipolar concepts and

what model to use instead. Applied Psychological Measurement,

18, 97�110.

Verheul, R. (2005). Taxonomic implications of three prospective

studies on the course and outcome of personality disorders.

Journal of Personality Disorders, 19(5), 581�585.

Widiger, T. A., Simonson, E., Sirovatka, P. J., & Regier, D. A.

(Eds.). (2006). Dimensional models of personality disorders.

Refining the research agenda for DSM-V. Arlington, VA: Amer-

ican Psychiatric Association.

Wilson, A., & Gedo, J. (1993). Hierarchical concepts in psycho-

analysis. New York: Guilford Press.

Zimmerman, M., & Coryell, W. (1989). DSM-III personality

diagnosis in a nonpatient sample. Demographic correlates and

comorbidity. Archives of General Psychiatry, 46(8), 682�689.

12 M. Polak et al.

Downloaded By: [Polak, Marike] At: 10:23 25 November 2009

Appendix A

The Developmental Profile Matrix

Problem solving

Social attitudes Object relationships Self-images Norms Needs Cognitions Thoughts/feelings Actions

Miscellaneous

themes

80: Generativity 81. Responsibility 82. Care 83. Authentic

self-image�social

84. Authentic

norms�social

85. Integrity 86. Context-related

cognitions

87. Respect for

controversial

(sub)cultures

88. Reorganization 89. Mourning

70: Solidarity 71. Living

together

72. Mate 73. Authentic 74. Authentic

norms�relational

75. Intimacy 76. Empathy 77. Respect for the

controversial other

78. Alliance 79. Collectivity

60: Individuation 61. Productivity 62. Equal 63. Authentic

self-image�individual

64. Authentic

norms�individual

65. Identity 66. Self-reflection 67. Respect for the

controversial self

68. Assertiveness 69. Primary-process

experiences

50: Rivalry 51. Status 52. Unattain-able

love

53. Ideal-related

self-image

54. Excessive ideals 55. Triumph 56. Histrionic

cognitions

57. Reversal 58. Pretending 59. Feelings of

sexual insufficiency

40: Resistance 41. Defiance 42. Oppressor 43. Norm-related

self-image

44. Excessive norms 45. Domination 46. Objectifying

cognitions

47. Elimination 48. Defensiveness 49. Moral

masochism

30: Symbiosis 31. Dependence 32. Parent 33. External

self-image

34. External norms 35. Passive

need for love

36. Suggestive

cognitions

37. Detachment 38. Giving up 39. Lack of basic trust

20: Egocentricity 21. Soloist 22. Servant 23. Overrated

self-image

24. Selfish

norms

25. Mirroring 26. Self-referring

cognitions

27. Disclaiming 28. Self-

overestimation

29. Coldness

10: Fragmentation 11. Changeability 12. Frame 13. Vague

self-image

14. Dichotomous

norms

15. Sensation

seeking

16. Nonpersonality

related cognitions

17. Primitive

externalization

18. Acting out 19. Dissociation

00: Lack of

Structure

1. Bizarre

behaviour

2. Lack of

affectivity

3. Lack of a

self-image

4. Lack of norms 5. Primary

satisfaction

of needs

6. Lack of

psychological

phenomena

7. Falsification 8. Impulsive

behaviour

9. Disorganization

Note. The item scores (range, 0�3) at one level are summed to obtain the level score.

The

dev

elopm

enta

lprofile

13

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Appendix B

Description of the levels of the Developmental Profile

Developmental level Description Example of the multiple meanings of behaviour: The patient resigns . . .

Generativity (80) To care for others or for society in general Because the project he was to be in charge of has too many negative

consequences for the environment

Solidarity (70) To establish longer lasting and mutually satisfactory relationships Because he feels that one of his co-workers was wrongly dismissed

Individuation (60) To realize one’s own aims, taking into account existing possibilities,

as well as the interests of others.

Because he is not given the resources necessary to carry out his work properly

Rivalry (50) Insecurity about one’s own qualities as an adult man or woman,

with a strong need to prove oneself socially

Because he has ‘‘lost face’’ after not being selected for a higher position

Resistance (40) Lack of inner freedom manifested by conflicts of autonomy Because he feels belittled by a colleague

Symbiosis (30) Functioning dependent from others Because he misses the support of his former boss, who has retired

Egocentricity (20) Narcissistic functioning with overestimated self-image and using

relationships

Because ‘‘those clueless idiots at work (management)’’ refused to accept his

plans

Fragmentation (10) Not able to integrate experiences manifestations as changeability,

splitting, or primitive externalisation (17)

‘‘For no reason’’ the same day his therapist announces his vacation

Lack of Structure (00) Lack of basic abilities such expressing affects or disturbances in

reality testing

In anger, and without stopping to think, when his boss does not agree to his

taking the following day off

Note. In the final column, an example is given that shows how the same behavior of a patient (here, resigning) could be placed on various levels of the DP, pending the context.

14

M.

Pola

ket

al.

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