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Journal of Personality Assessment

ISSN: 0022-3891 (Print) 1532-7752 (Online) Journal homepage: http://www.tandfonline.com/loi/hjpa20

Multisurface Interpersonal Assessment in a


Cognitive-Behavioral Therapy Context

Sindes Dawood & Aaron L. Pincus

To cite this article: Sindes Dawood & Aaron L. Pincus (2016) Multisurface Interpersonal
Assessment in a Cognitive-Behavioral Therapy Context, Journal of Personality Assessment,
98:5, 449-460, DOI: 10.1080/00223891.2016.1159215

To link to this article: http://dx.doi.org/10.1080/00223891.2016.1159215

Published online: 12 Apr 2016.

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JOURNAL OF PERSONALITY ASSESSMENT
2016, VOL. 98, NO. 5, 449460
http://dx.doi.org/10.1080/00223891.2016.1159215

CLINICAL CASE APPLICATIONS

Multisurface Interpersonal Assessment in a Cognitive-Behavioral Therapy Context


Sindes Dawood and Aaron L. Pincus
Department of Psychology, The Pennsylvania State University

ABSTRACT ARTICLE HISTORY


The interpersonal paradigm of personality assessment provides a rich nomological net for describing and Received 22 September 2015
assessing constructs of interpersonal functioning. The aim of this article is to demonstrate for clinicians Revised 9 January 2016
how the use of a multisurface interpersonal assessment (MSIA) battery can augment psychotherapy (e.g.,
cognitive-behavioral therapy). We present 2 clinical case examples and specify interpretative guidelines
for MSIA that integrate multiple circumplex proles (e.g., problems, traits, sensitivities, strengths, values,
and efcacies) for each patient. Subsequently, we demonstrate how this approach provides a context
to better understand patient symptoms and difculties, and discuss how it can inform case
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conceptualization, treatment planning, and intervention.

Interpersonal assessment makes use of multiple models, meas- values, efcacies, sensitivities, strengths), and specic interper-
ures, and methods at varying levels of specicity and combines sonal behaviors. A well-validated and clinically useful model
these with theories of development, motivation, and regulation for organizing, describing, and assessing these various interper-
to examine the interpenetration of personality, psychopathol- sonal dispositions is the interpersonal circumplex (IPC) model
ogy, and psychotherapy (Pincus, 2010, p. 467). Importantly, (Figure 1, bottom; Fournier, Moskowitz, & Zuroff, 2011;
interpersonal assessment can be used to articulate both struc- Wiggins, 1996). As one moves around the circle, each octant
tural dynamics of personality within the person and temporal reects blends of agency and communion. The bottom circle in
dynamics of personality emerging across time and situations Figure 1 provides an example of how interpersonal traits and
(Hopwood, Zimmerman, Pincus, & Krueger, 2015; Pincus, problems are conceptualized with the IPC. Although the
Sadler, et al., 2014). This article focuses on the former and two-letter labels have no substantive meaning, they serve as
presents a structural approach to assessing interpersonal useful metalabels for octants when employing two or more IPC
dynamics. We demonstrate the use of a multisurface interper- surfaces,1 as we do here.
sonal assessment (MSIA) battery to identify and understand
consistency and conict across different interpersonal levels of
personality (e.g., Leary, 1957). We aim to demonstrate, with Personality structure and intrapsychic conicts
two psychotherapy cases, how an MSIA battery can be fruitfully
and straightforwardly used in the consulting room and adapted Originating in the work of Leary (1957) is the recognition that
to the cognitive-behavioral therapy (CBT) context. personality can be assessed at different levels and articulated
using the IPC. Leary argued that assessing consistencies and
discrepancies across different interpersonal levels of personality
is important, as conicts across levels have implications for a
The interpersonal circumplex
persons psychological functioning. The SASB (Benjamin, 1974,
The interpersonal paradigm of personality assessment 1996) was developed as an extension of Learys interpersonal
(Wiggins, 2003) is anchored by the organizational metaframe- circumplex, but rather than represent interpersonal tendencies
work of agency and communion for understanding human by a single surface, it consists of three circumplex surfaces, two
motivation and behavior (Figure 1, top). Whereas agency of which focus on interpersonal experiences and interactions
emphasizes autonomy, separation, and dominance, commu- (self and other) and the third that focuses on self-concept con-
nion emphasizes a sense of closeness, belonging to others, and sistency and inconsistency. Benjamins (2000) SASB Intrex
forming relationships (Bakan, 1966; Wiggins, 1991). This Questionnaire scoring routine includes calculation of within-
approach provides the groundwork for dening and assessing surface conict coefcients representing attachment conicts
important constructs of interpersonal functioning at different (communion) and autonomy conicts (agency; Alpher, 1991;
levels of specicity, including more general interpersonal goals Armelius & Granberg, 2000; Benjamin, 1984), and her interpre-
and motives, interpersonal dispositions (e.g., traits, problems, tive approach also includes cross-surface comparisons

CONTACT Sindes Dawood szd157@psu.edu Department of Psychology, Pennsylvania State University, 361 Moore Bldg., University Park, PA 16802.
1
The terms surfaces and proles are used interchangeably in this article, because they are equivalent when discussing the structural analysis of social behavior (SASB;
Benjamin, 1974) system and the interpersonal circle model (Kiesler, 1983).

2016 Taylor & Francis


450 DAWOOD AND PINCUS

are associated with emotional distress (e.g., depression, anxiety)


and relationship dissatisfaction (Campbell et al., 1996; Lewan-
dowski, Nardone, & Raines, 2010; Sollberger et al., 2012). In
sum, studying and understanding self- and relational conicts
is not only found in the interpersonal paradigm of personality
assessment, but also in contemporary psychodynamic and per-
sonality literature. This article aims to demonstrate how identi-
fying and understanding coherence and conict within and
across different interpersonal levels of personality can be useful
in the context of CBT.

A cognitive-behavioral case formulation to CBT


Clinicians have increasingly viewed case conceptualization as a
core aspect of CBT (Flitcroft, James, Freeston, & Wood-Mitch-
ell, 2007). A cognitive-behavioral (CB) case formulation is an
empirical hypothesis-testing approach that entails assessment,
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formulation, and intervention (Persons & Tompkins, 1997).


The clinician begins by gathering assessment data to obtain a
diagnosis as well as an initial conceptualization (formulation)
of the clinical case. The formulation is a working hypothesis
about the psychological mechanism(s) that drive and sustain
the patients problems, which can then be used to guide specic
treatment interventions by providing a basis for the treatment
plan. Furthermore, the clinician returns to the assessment
phase many times, gathering data to monitor the patients
progress throughout therapy and using these data to modify
the formulation and treatment as necessary.
According to Persons and Tompkins (1997), a comprehen-
sive case formulation takes into account the patients problems
in any of the following domains: psychological and psychiatric
symptoms, and medical, interpersonal, occupational, nancial,
Figure 1. Agency and communion metaframework (top); the Interpersonal Cir-
cumplex (IPC; bottom). school, and legal difculties, because in order to understand
the case fully, the therapist must know what all the problems
are and how they are related (p. 294). This assumes that either
(Benjamin, 1994, 1995). This article is the rst to explicitly con- the patient is cognizant of having problems in these domains
sider within- and between-surface consistency and conict such that he or she can verbalize them for a problems list, or
using an MSIA battery. that the therapist is able to recognize areas or issues where the
There is evidence that some personality disorders (e.g., bor- patient might lack awareness. For instance, although a patient
derline personality) are related to inconsistent interpersonal might be aware of experiencing general interpersonal difcul-
traits or styles (Hopwood & Morey, 2007; Kiesler, 1996), and ties, he or she might not be aware of the role they play in his or
that intrapsychic conicts could be important for understand- her experience of problems with others (e.g., how the patients
ing why some persons experience disturbed interpersonal rela- behavior can evoke certain responses from others, how the
tions (e.g., Benjamin, 1993; Kiesler, 1996). For instance, patients behavior is perceived by others, or the negative impact
according to Kernberg and Caligor (2005), personality distur- the patients behavior can have on others). The patient might
bance is characterized by a poorly integrated and inconsistent also not be aware of contradictions in his or her self that could
sense of self and others (i.e., identity diffusion). Such identity also have implications for how he or she interacts with others.
diffusion is thought to relate to splitting (seeing self and Finally, the therapist is not a mind reader, and thus if a patient
others as all good vs. all bad) and is concomitant with inconsis- is vague in or resistant to discussing his or her behaviors and
tent interpersonal behaviors (e.g., vacillations between warm feelings toward others, the clinician might miss important
and cold behaviors). Clinically this is relevant, as higher levels details that could help with case formulation and treatment
of variability in interpersonal behaviors have been connected to planning in this domain. An MSIA might offer the therapist an
interpersonal distress (Erikson, Newman, & Pincus, 2009), efcient and rich opportunity to better understand the patients
poorer relationships (C^ ote, Moskowitz, & Zuroff, 2012), and interpersonal dynamics and shed light on areas of conict,
psychopathology (e.g., anxiety, borderline personality disorder; which would seem valuable, especially with patients for whom
Rappaport, Moskowitz, & DAntono, 2014; Russell, Moskowitz, relational problems are central. This additional information
Zuroff, Sookman, & Paris, 2007). Similarly, intrapsychic con- could then be synthesized and integrated into the CB case for-
icts (e.g., identity diffusion, low or lack of self-concept clarity) mulation to enhance treatment decisions.
MULTISURFACE INTERPERSONAL ASSESSMENT 451

Multisurface interpersonal assessment Interpersonal inventories and symptom measures


Assessing a range of interpersonal dispositions using multiple Assessing multiple domains of interpersonal functioning (e.g.,
validated IPC-based measures (Hopwood et al., 2011; Locke, traits, sensitivities, problems, strengths) could provide insight
2011) creates a multisurface perspective on patient functioning into the structural dynamics of a patients personality. As such,
that adds to standard IPC prole interpretation for a single the patients presented here completed six validated IPC meas-
measure or surface (Gurtman & Balakrishnan, 1998). This mul- ures that represent a broad range of adaptive and maladaptive
tisurface approach, rst recommended by Kiesler (Van interpersonal dispositions. Each measure has eight scales that
Denburg, Schmidt, & Kiesler, 1992) and implemented in Wig- are constructed to assess the octants of the IPC. These scales
ginss (2003) seminal collaborative case study of Madeline G. are identied by their angular positions (and two-letter codes)
(Pincus & Gurtman, 2003), provides a lens for the clinician to around the circumplex, ranging from 0 to 360 . In what fol-
see a larger scope of the patients social and inner world that lows, we describe in more detail the self-report instruments
otherwise might be missed. By considering the convergences completed by the patients.
and divergences between a patients prole of interpersonal Interpersonal traits, reecting generalized behavioral ten-
traits, values, problems, efcacies, strengths, and sensitivities, dencies, were assessed with the 32-item International Personal-
we nd clinically useful information that informs how to ity Item PoolIPC (IPIPIPC; Markey & Markey, 2009).
understand a patients presenting problems (e.g., depressed Interpersonal problems, reecting distressing behavioral
mood, anxiety, suicidal ideation). Perhaps the patient greatly excesses and inhibitions, were assessed with the 32-item Inven-
values interpersonal warmth (communion), but he does not tory of Interpersonal ProblemsShort Circumplex (IIPSC;
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feel he has the efcacy to connect with others, is distressed over Soldz, Budman, Demby, & Merry, 1995). Interpersonal sensi-
his isolation, but also is highly averse to others showing him tivities, reecting the behaviors of others that a patient nds
affection. This multisurface portrait of the conict over close- bothersome, were assessed with the 64-item Interpersonal Sen-
ness and distance highlights the interpersonal dynamics of per- sitivities Circumplex (ISC; Hopwood et al., 2011). Interpersonal
sonality. This can help to develop clinically testable hypotheses values, reecting the importance the patient ascribes to certain
about patient functioning and identify treatment targets that interpersonal experiences or behaviors, were assessed with the
are easy for clinicians to articulate and easy for patients to 64-item Circumplex Scales of Interpersonal Values (CSIV;
understand. Locke, 2000). Interpersonal efcacies, reecting the patients
Two published brief case studies (Hopwood, Pincus, & reported condence in enacting specic interpersonal behav-
Wright, in press; Pincus, Sadler, et al., 2014) have demonstrated iors, were assessed using the 32-item Circumplex Scales of
how MSIA batteries can be useful in helping patients and thera- Interpersonal Efcacy (CSIE; Locke & Sadler, 2007). Finally,
pists collaboratively identify interpersonal dynamics, providing interpersonal strengths reecting highly adaptive interpersonal
a context to better understand symptoms and difculties. The features were assessed with the 32-item short form of the
results of the assessments and the insights gained by the Inventory of Interpersonal Strengths (IIS32; Hatcher &
patients guided new treatment recommendations targeting Rogers, 2012).
aspects of the patients interpersonal functioning. Although Additionally, patients were assessed for a breadth of issues
these cases demonstrated the utility of assessing and conceptu- related to psychiatric symptomatology and daily functioning
alizing the interpersonal dynamics of patients in the consulting using the standardized Treatment Outcome Package (TOP;
room, neither provided specic guidelines for interpreting mul- Kraus, Seligman, & Jordan, 2005). This measure allows clini-
tisurface IPC proles. This article extends the prior case studies cians to track positive or negative change in symptoms and
by specifying an interpretive approach for clinicians to inform functioning throughout treatment. The patients completed the
case conceptualization and treatment planning. TOP at intake and prior to each therapy session as part of a
clinic-based practice research network (Castonguay, Pincus, &
McAleavey, 2015).
Two clinical cases
Case material is drawn from MSIAs with two clinical outpatients
in CBT.2 First we describe the interpersonal inventories and Interpreting interpersonal inventories
symptom measures that were completed by both patients, and The structural summary method for circumplex data (see
how to organize the interpersonal assessment data. Second, for Figure 2; Gurtman & Balakrishnan, 1998) was used to examine
each patient, we discuss the rationale for the assessment; and then each patients interpersonal data. According to this approach,
we examine their set of six IPC proles (surfaces) from an individ- each IPC prole of eight octant scale scores can be summarized
ual and multisurface perspective to identify clinically meaningful by four structural parameterselevation, angular displacement,
convergences or divergences for possible interpretation. Third, amplitude, and prototypicalityand these parameters can
we discuss linking the interpersonal assessment results to CBT inform case formulation. IPC octant scores were obtained from
interventions. Fourth, we review the patients symptomatic standardized z score transformations relative to available nor-
changes after implementing those interventions. Finally, we sum- mative data. Elevation (e) reects the average scale score across
marize the clinical implications of the MSIA approach. an eight-octant prole that offers a substantive interpretation
for some IPC measures. For example, IIPSC elevation indi-
2
Both patients provided informed written consent to present their assessment cates the overall level of distress and ISC elevation indicates
results and case information. general interpersonal sensitivity. Because an elevation score
452 DAWOOD AND PINCUS

that is near zero is considered average, we suggest concentrat-


ing on scores at least .5 SD above or below the mean for inter-
pretationalthough elevation scores at least 1 SD above or
below the mean are likely to be more clinically signicant
(elevation score .5 SD above or below the mean can be consid-
ered a moderate effect, whereas a score 1 SD above or below
the mean can be considered a large effect). Angular displace-
ment (Q) captures the main interpersonal theme or style of the
prole. Amplitude (a) reects the specicity of the interper-
sonal theme. Finally, R2, or goodness of t, quanties the t of
the actual prole of octant scores to an expected circular pat-
tern (a sinusoidal curve), characterizing the circular prototypi-
cality (vs. complexity) of the prole (i.e., prototypicality). A
good (R2 value > .80) or adequate (R2 value  .70) t demon-
strates that the prole can be well summarized by its other
parameters (note that e is interpretable regardless of prole Figure 2. Circumplex structural summary example. Note. X axis D circumplex
angle in degrees; Y axis D standard (z) score on the Inventory of Interpersonal
prototypicality; Gurtman & Balakrishnan, 1998; Pincus & Gurt- ProblemsShort Circumplex (IIPSC) octant.
man,, 2003; Wright, Pincus, Conroy, & Hilsenroth, 2009; Zim-
merman & Wright, 2015). Thus, a low R2 value (<.70) suggests
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low prototypicality, or high prole complexity, such that the Mr. B reported problems with depression, it was later claried
prole is best interpreted at the octant level. We implement the with his therapist3 that he experienced an empty depression
structural summary approach in combination with specic characterized by anhedonia, feelings of worthlessness, and
octant interpretations in two clinical case illustrations. boredom with life rather than a melancholic depression domi-
When examining the results of a multisurface interpersonal nated by sad affects. Clinical case studies and newly emerging
battery, we recommend clinicians follow these steps: research demonstrates that the former is often seen in narcissis-
1. Examine prototypical proles (R2 value  .70) with the tic patients and college students (Dawood & Pincus, 2015; Pin-
structural summary method. cus, Cain, & Wright, 2014; Pincus, Roche, & Good, 2015).
2. Examine multiple peaks in complex IPC proles with Following a CB case formulation approach (Persons, 1989),
low prototypicality (R2 < .70) using a graphical Mr. B and his therapist created an exhaustive and detailed list
representation. of his current and long-standing problems. General themes of
3. Make cross-surface comparisons using a graphical repre- this list included emotional dysregulation, interpersonal dif-
sentation. More specically, whereas in Step 2 the asses- culties, a tendency to engage in impulsive, maladaptive behav-
sor is interested in identifying conicts or discrepancies iors (e.g., unprotected sexual promiscuity, excessive
in interpersonal themes within the same surface, Step 3 pornography consumption), and maladaptive beliefs (e.g., its
involves identifying conicts or discrepancies in inter- me vs. the world; women are sex objects). In particular, his top
personal themes across different surfaces. 3 out of 13 difculties were the following: lashing out or being
Next, we present two clinical case examples to demonstrate passive-aggressive with others, having a difcult time seeing
the usefulness and strength of this MSIA approach. positive things for himself, and the general avoidance of people
and feeling very uncomfortable around others.
CBT protocols for depression were effective at reducing
Case example 1: Mr. B Mr. Bs depressive symptoms and suicidality (see Table 1,
Sessions 113). However, it did not appear effective at changing
Background and presenting problem
his dissatisfaction with life. Thus, an MSIA was offered as a way
Mr. B is a 39-year-old, high-school-educated, employed, single to help Mr. B better understand his dissatisfaction above and
male. He received outpatient psychotherapy twice in the past beyond symptom reduction. Next we walk the reader through
for depression, anxiety, and interpersonal difculties, and vol- the interpretation of the assessment results.
untarily hospitalized himself three times in the last 5 years. Mr.
B presented to the clinic reporting similar difculties. He com-
pleted a standard intake evaluation, including two semistruc- Examination of Mr. Bs interpersonal results
tured clinical interviews (Anxiety Disorders Interview
ScheduleIV [Brown, Di Nardo, & Barlow, 1994] to assess for Following our MSIA approach, we rst examine Mr. Bs struc-
DSMIV Axis I disorders and the International Personality Dis- tural summary results and identify any prototypical proles
orders Examination for DSMIV (Loranger, 1999) to assess for (Step 1). According to Table 2, he has three prototypical inter-
personality disorders), the TOP, and the IIPSC. He endorsed personal proles (R2  .70): traits, sensitivities, and values. Mr.
Diagnostic Statistical Manual of Mental Disorders (4th ed. Bs angular displacement (Q) and amplitude (a) on the traits
[DSMIV]; American Psychiatric Association, 1994) criteria surface suggests that he views his general interpersonal
for antisocial personality disorder (in partial remission), bor-
derline personality disorder, narcissistic personality disorder 3
The rst author of this article is the therapist for both patients presented in this
traits, and a past history of substance dependence. Although article and is supervised by a licensed clinical psychologist.
MULTISURFACE INTERPERSONAL ASSESSMENT 453

Table 1. Mr. Bs Treatment Outcome Package (TOP) scores over the course of therapy.

DEPRES LIFEQ MANIC PANIC PSYCS SA SCONF SEXFN SLEEP SUICD VIOLN WORKF

Preinterpersonal assessment
Intake 1 2.39 2.27 .23 .49 .23 .94 .72 .80 .43 2.39 3.09 .53
Intake 2 .66 1.68 .75 1.24 .23 .34 1.05 .80 .76 .19 3.09 1.01
Intake 3 1.21 2.01 .20 .28 .65 .34 1.15 .80 .09 .25 .28 .74
Session 1 2.94 3.06 .43 .62 .65 .34 1.57 .80 .43 .25 .28 2.69
Session 2 1.66 2.53 .68 .62 .65 .34 .35 .80 .09 .03 .28 .85
Session 3 1.51 2.80 .70 .62 .65 .34 1.15 .80 1.25 .03 .28 1.12
Session 4 1.39 3.06 .80 .21 .65 .34 1.15 .80 .24 .03 .28 .85
Session 5 .53 2.53 .93 .26 .65 .34 1.15 .80 .09 .03 .28 .88
Session 6 .54 2.53 .93 .62 .65 .34 1.15 .80 .09 .20 .28 .57
Session 7 1.07 2.53 .20 .08 .65 .34 1.15 .80 .09 .03 .28 .05
Session 8 1.21 2.53 .80 .62 .65 .34 1.15 .80 .43 .03 .28 1.12
Session 9 .10 2.21 .93 .26 .65 .34 1.15 .80 .39 .20 .28 1.12
Session 10 .65 3.06 .81 .62 .65 .34 1.15 .80 .43 .03 .28 1.12
Session 11 .37 2.53 .93 .62 .65 .34 1.15 .80 .43 .03 .28 1.12
Session 12 .22 1.90 .93 .62 .65 .34 1.15 .80 .43 .03 .28 1.12
Session 13 .22 2.53 .93 .62 .65 .34 1.15 .80 .21 .03 .28 1.12
Sessions 113 avg. .95 2.60 .74 .48 .65 .34 .88 .80 .09 .01 .28 .63
Postinterpersonal assessment
Session 14 .10 2.80 .93 .62 .65 .34 1.15 .80 .09 .20 .28 1.12
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Session 15 .22 1.90 .93 .62 .65 .34 1.15 .80 .09 .03 .28 1.12
Session 16 .22 2.53 .93 .62 .65 .34 1.15 .80 .09 .03 .28 1.12
Session 17 .22 1.90 .93 .62 .65 .34 1.15 .80 .09 .03 .28 1.12
Session 18 .38 2.53 .93 .62 .65 .34 1.15 .80 .09 .03 .28 1.12
Session 19 .22 2.21 .93 .62 .65 .34 1.15 .80 .09 .03 .28 1.12
Session 20 .53 4.23 .93 .62 .65 .34 .76 .80 .09 .03 .28 .01
Session 21 .37 1.91 .93 .62 .65 .34 1.15 .80 .39 .03 .28 1.12
Sessions 1421 avg. .28 2.50 .93 .62 .65 .34 1.10 .80 .13 .00 .28 .98
Change in treatment modality
Session 22 2.09 3.96 .20 .62 .17 .34 1.15 .80 1.85 1.59 1.74 .18
Session 23 .78 2.21 .80 .62 .65 .34 1.15 .80 .58 .03 .28 1.12
Session 24 .78 1.37 .80 .62 .65 .34 1.15 .80 .09 .03 .28 1.12
Session 25 1.08 2.22 .68 .62 .65 .34 1.15 .80 .88 .03 .28 1.12
Session 26 1.08 1.37 .68 .62 .65 .34 1.15 .80 1.55 .03 .28 1.12
Session 27 .64 1.63 .80 .62 .65 .34 1.15 .80 .88 .03 .28 1.12
Session 28 1.08 1.95 .68 .62 .65 .34 1.15 .80 .85 .20 .28 1.12
Session 29 .78 1.64 .68 .62 .65 .34 1.15 .80 .21 .20 .28 1.12
Session 30 1.06 1.53 .86 .62 .65 .34 1.15 .80 .63 .03 .28 1.12
Sessions 2230 avg. .91 1.74 .75 .62 .65 .34 1.15 .80 .69 .03 .28 1.12
Sessions 1430 avg. .68 2.23 .80 .62 .62 .34 1.13 .80 .37 .08 .16 .98

Note. DEPRES D depression; LIFEQ D life quality; PSYCS D psychosis; SA D substance abuse; SCONF D social conict; SEXFN D sexual functioning; SUICD D suicidal idea-
tion; VIOLN D violence; WORKF D work functioning. Degrees of shading indicate severity level of symptoms such that the light gray box D mild; dark gray box D mod-
erate; and the black box D severe. Negative values indicate strengths. A high value is problematic (e.g., a high LIFEQ score indicates low quality of life). Of note, the
client presented to intake Sessions 1 and 2 with increasing thoughts of hurting others; the dramatic reduction in violence is likely to be the result of catharsis. Mr. B
reported harboring much anger toward specic individuals as well as people more generally, and used the intake to express these intense feelings that he felt he could
not share with others.

Table 2. IPC measure scale scores and structural summary parameters for Mr. Bs assessment.
Standardized scale scores Structural summary
       
PA (90 ) BC (135 ) DE (180 ) FG (225 ) HI (270 ) JK (315 ) LM (0 ) NO (45 ) e a Q R2

Traits (IPIPIPC) .60 .90 2.19 2.11 .44 .96 1.18 2.17 .09 2.05 199.60 .95
Sensitivities (ISC) .08 .30 2.52 1.35 .16 1.98 3.63 1.82 .51 2.41 5.75 .87
Values (CSIV) 1.34 2.11 3.61 2.52 4.81 .98 .12 .12 1.92 1.90 215.09 .72
Efcacies (CSIE) .45 .83 1.34 1.44 .31 .18 1.14 .08 .66 .50 186.49 .37
Problems (IIPSC) .36 3.20 2.46 2.85 .91 .43 1.86 .34 1.47 1.22 189.94 .50
Strengths (IIS) 1.26 .83 2.09 1.47 2.51 2.50 2.34 .59 1.70 .79 104.87 .61

Note. IPC D The Interpersonal Circumplex; e D elevation; a D amplitude; Q D angular displacement; IPIPIPC D International Personality Item PoolIPC; ISC D Interper-
sonal Sensitivities Circumplex; CSIV D Circumplex Scales of Interpersonal Values; CSIE D Circumplex Scales of Interpersonal Efcacies; IIPSC D Inventory of Interper-
sonal ProblemsShort Circumplex; IIS D Inventory of Interpersonal Strengths; IPIPIPC PA D domineering; IPIPIPC BC D vindictive; IPIPIPC DE D cold-hearted; IPIP
IPC FG D socially-avoidant; IPIPIPC HI D nonassertive; IPIPIPC JK D exploitable, IPIPIPC LM D overly nurturant; IPIPIPC NO D intrusive; ISC PA D sensitive to con-
trol; ISC BC D sensitive to antagonism; ISC DE D sensitive to remoteness; ISC FG D sensitive to timidity; ISC HI D sensitive to passivity; ISC JK D sensitive to dependence;
ISC LM D sensitive to affection; ISC NO D sensitive to attention-seeking; CSIV PA D agentic; CSIV BC D agentic and separate; CSIV DE D separate; CSIV FG D submissive
and separate; CSIV HI D submissive; CSIV JK D submissive and communal; CSIV LM D communal; CSIV NO D agentic and communal; CSIE PA D dominant; CSIE BC D
dominant and distant; CSIE DE D distant; CSIE FG D yielding and distant; CSIE HI D yielding; CSIE JK D yielding and friendly; CSIE LM D friendly; CSIE NO D dominant
and friendly; IIPSC PA D assured-dominant; IIPSC BC D arrogant-calculating; IIPSC DE D cold-hearted; IIPSC FG D aloof-introverted; IIPSC HI D unassured-submis-
sive; IIPSC JK D unassuming-ingenuous; IIPSC LM D warm-agreeable; IIPSC NO D gregarious-extraverted; IIS PA D lead; IIS BC D direct; IIS DE D balance; IIS FG D
restrain; IIS HI D cooperate; IIS JK D consider; IIS LM D connect; IIS NO D engage.
454 DAWOOD AND PINCUS

behavior as distinctly cold and aloof.4 On the sensitivities sur-


face, he is moderately more bothered by others in general than
average (e) and distinctly does not like people getting too close
to him (Q, a). On the values surface, he generally values inter-
personal experiences (e), and places a distinct emphasis on
being passive (Q, a).
We now turn to Step 2 of the MSIA approach and use a
graphical representation to examine complex proles exhibiting
multiple peaks at the octant level rather than using structural
summary parameters other than elevation, which is interpret-
able regardless of prole complexity. Mr. Bs prole on the ef- Figure 3. Interpersonal structural summary proles for Mr. B. Note. IIPSC D Inven-
cacies surface is complex (low R2), and Figure 3 and Table 2 tory of Interpersonal ProblemsShort Circumplex; IPIPIPC D International Person-
illustrate a moderate general elevation (e) with peaks on the ality Item PoolThe Interpersonal Circumplex; CSIE D Circumplex Scales of
Interpersonal Efcacies; CSIV D Circumplex Scales of Interpersonal Values; ISC D
cold (DE) and withdrawn (FG) octants and a contrasting peak Interpersonal Sensitivities Circumplex; IIS D Inventory of Interpersonal Strengths;
on the warm (LM) octant. Mr. B feels most condent he can IIPSC PA D assured-dominant; IIPSC BC D arrogant-calculating; IIPSC DE D
stay separate from others and also feels condent he can be cold-hearted; IIPSC FG D aloof-introverted; IIPSC HI D unassured-submissive;
IIPSC JK D unassuming-ingenuous; IIPSC LM D warm-agreeable; IIPSC NO D
close to others. Similarly, Mr. B reports interpersonal problems gregarious-extraverted; IPIPIPC PA D domineering; IPIPIPC BC D vindictive;
with being both too cold and too warm with others, as shown IPIPIPC DE D cold-hearted; IPIPIPC FG D socially-avoidant; IPIPIPC HI D nonas-
sertive; IPIPIPC JK D exploitable, IPIPIPC LM D overly nurturant; IPIPIPC NO D
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by the peaks on cold (DE) and overly-nurturant (LM), respec-


intrusive; CSIE PA D dominant; CSIE BC D dominant and distant; CSIE DE D distant;
tively. Moreover, the high elevation on the IIPSC indicates CSIE FG D yielding and distant; CSIE HI D yielding; CSIE JK D yielding and friendly;
that he is markedly distressed by these problems. Mr. Bs prole CSIE LM D friendly; CSIE NO D dominant and friendly; CSIV PA D agentic; CSIV BC
of interpersonal strengths was most strongly characterized by D agentic and separate; CSIV DE D separate; CSIV FG D submissive and separate;
CSIV HI D submissive; CSIV JK D submissive and communal; CSIV LM D communal;
very low elevation, suggesting a strong and global denial of pos- CSIV NO D agentic and communal; ISC PA D sensitive to control; ISC BC D sensi-
itive interpersonal qualities. This prole is consistent with him tive to antagonism; ISC DE D sensitive to remoteness; ISC FG D sensitive to timid-
not being able to see positive things for himself. ity; ISC HI D sensitive to passivity; ISC JK D sensitive to dependence; ISC LM D
sensitive to affection; ISC NO D sensitive to attention-seeking; IIS PA D lead; IIS BC
The nal step of the MSIA approach is to use a graphical D direct; IIS DE D balance; IIS FG D restrain; IIS HI D cooperate; IIS JK D consider;
representation to make cross-surface comparisons (Figure 3). IIS LM D connect; IIS NO D engage.
Mr. Bs structural dynamics illustrate that he himself plays a
role in blocking his ability to engage in and form more satisfy-
ing interpersonal relationships. His MSIA results indicate he well as resolve his conict over being warm (LM) with others.
values being passive, nds others affection bothersome, and is For instance, mindfulness was used to increase Mr. Bs aware-
distressed over being too warm toward others, further perpetu- ness of when he was judgmental or standofsh with others,
ating his isolation and loneliness. Although Mr. B also views when he had the impulse to avoid socializing or engaging in
his cold and aloof behavior as distressing, his interpersonal val- small talk with someone, or when he had the urge to reach
ues and sensitivities might negatively affect his willingness to out to one of his sex contacts for a one-night stand. These
change to be more connected with others and improve his satis- CBT interventions were employed from Session 14 to Session
faction with life. 21 (postinterpersonal assessment). Results from Table 1 suggest
that they did not seem to affect Mr. Bs dissatisfaction with life
and self. One possible reason the therapist and patient might
Linking Mr. Bs interpersonal data with CBT interventions have had difculty getting traction on this issue was that Mr. B
The therapist held a feedback session with Mr. B to go over his was often noncompliant and resistant to CBT and DBT home-
interpersonal results. According to Mr. B, the experience was work assignments, which was likely tied to his personality
mind-blowing, partly because he was impressed by how his pathology.
results on various interpersonal measures could make tangible Because the TOP does not assess for empty depression,
some of the interpersonal issues he has struggled to describe to and Mr. B was still reporting problems with depression at
his therapist. For instance, Mr. Bs CSIV (values) scores helped the time of the interpersonal feedback session, the therapist
demonstrate that he does in fact value interpersonal experien- began having Mr. B complete the Mood and Anxiety Symp-
ces, despite often avoiding them, but he has a difcult time tom QuestionnaireShort Form (MASQ; Watson & Clark,
expressing this directly. 1991), which assesses both symptoms of depression and
The data from this assessment were used to guide new CBT anhedonia, prior to each session starting with Session 14.
interventions to help address some of Mr. Bs interpersonal dif- According to the MASQ, loss of interest and lack of posi-
culties. For instance, the therapist implemented dialectical tive affect are both aspects of anhedonia. As shown in
behavioral therapy (DBT) skills training including mindfulness Figure 4, after the interpersonal feedback session and the
and interpersonal effectiveness (Linehan, 1993, 2014) to application of new CBT interventions targeting interper-
decrease Mr. Bs coldness (DE) and social avoidance (FG), as sonal functioning (e.g., mindfulness) from Session 14 to 21,
Mr. Bs depressive and general distress symptoms and loss
4 of interest decreased. However, his lack of positive affect
Like other IPC measures of general interpersonal traits (e.g., the Interpersonal
Adjective Scales; Wiggins, 1991), the IPIPIPC has a negligible elevation had not notably changed, indicating that the patient lacked
parameter. positive reinforcements and pleasant moods.
MULTISURFACE INTERPERSONAL ASSESSMENT 455

was the core belief that Ms. A is inferior, defective, unattractive,


and socially inept relative to other adults. Although Ms. As
tendency was to withdraw and avoid others, she frequently
reported to her therapist that she wanted her voice to be heard
by others.
Ms. As TOP (see Table 3) shows that she particularly strug-
gled with depression, dissatisfaction with life, panic-like symp-
toms, and sleep disturbance at the start of therapy. Thus,
various CBT protocols for depression and anxiety were used to
Figure 4. Mr. Bs depressive symptoms on the Mood and Anxiety Symptom Ques- address these symptoms. It is clear from Table 3 that over the
tionnaire (MASQ) over the course of therapy: Postinterpersonal assessment. course of CBT (Sessions 127), many of her specic symptoms
(e.g., depression, panic, sleep disturbance) decreased. However,
by Session 27, despite quite notable symptom relief, Ms. A was
Interestingly, around the time of Session 22, the therapist still not feeling good about herself or her life (similar to Mr. B).
began taking a less structured CBT and DBT approach to Therefore, an MSIA was recommended to help Ms. A and her
psychotherapy due to a change in clinical supervision. Start- therapist better understand her dissatisfaction beyond symp-
ing with Session 22, the therapist no longer assigned the tom relief.
patient homework activities based on DBT, but rather used
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the sessions to help the patient explore and understand


Examination of Ms. As interpersonal results
how his maladaptive schemas affected his interpersonal
relationships and social interactions and expectations for Following our recommended MSIA approach, we rst examine
continued negative experiences. During this period of time Ms. As structural summary results and identify any prototypi-
(Sessions 2230), on his own accord, Mr. B continued to cal proles (Step 1). As shown in Table 4, Ms. A has only one
apply mindfulness techniques (e.g., approaching experiences prototypical prole (R2  .70), namely, efcacies (CSIE). Her
nonjudgmentally, doing one thing at a time) and relation- angular displacement (Q) and amplitude (a) indicate that she
ship effectiveness skills (e.g., acting interested, being truth- feels distinctly condent in being passive and following direc-
ful) to his daily interpersonal experiences. Mr. B shared tions. The prole also exhibits moderately low elevation (e),
with his therapist that putting in this effort helped him be indicating she lacks interpersonal condence in general. The
less distant and socially avoidant with others, and allowed remaining proles have an R2 <.70, suggesting complexity, and
others and himself to see that he can be warm and friendly thus should be interpreted at the octant level using a graphical
in a genuine manner rather than in a manipulative way. In representation.
turn, Mr. B began to recognize that he could have positive Following Step 2 of the MSIA approach, we see in Figure 5
experiences and see that he is not the worthless person he and Table 4 that Ms. As traits and problems proles both have
always believed himself to be. Indeed, as shown in Table 1, peaks in the (FG) and (LM) octants. That is, Ms. A views her
Mr. Bs scores on life quality began to improve much more general interpersonal behavior as both withdrawn and warm,
than before (see Sessions 2230). Figure 4 illustrates that and reported problems with being both socially avoidant and
during this time period, Mr. Bs depressive symptoms, loss overly nurturant. Moreover, her problems prole is markedly
of interest, and lack of positive affect also decreased, indi- elevated (e), suggesting considerable generalized interpersonal
cating that he began experiencing more pleasure in life and distress. Ms. As sensitivities prole is also complex such that
became somewhat happier with himself. it exhibits peaks in the sensitive to affection (LM) and sensitive
to antagonism (BC) octants. Notably, other than these two
peaks, her elevation (e) score on her ISC prole suggests she is
Case example 2: Ms. A generally not bothered by the behaviors of others more than
average; however, this could be due to her social avoidance. Ms.
Background and presenting problems
As values prole is also complex in that she exhibits peaks in
Ms. A is a 44-year-old, divorced female with hemiparesis. She both FG and JK octants, suggesting she feels it is important to
has an associates degree and works full-time as a day care conceal herself from others to avoid rejection and ridicule and
teacher. She presented to the clinic with symptoms of depres- that she values deferring to and being accepted by others
sion and anxiety following a job termination. She completed (Locke, 2000). Like Mr. B, Ms. As prole of interpersonal
the same standard intake evaluation as Mr. B (described previ- strengths was also most strongly characterized by very low ele-
ously). During the intake assessment process, she also reported vation, suggesting a strong and global denial of positive inter-
long-standing distress about interpersonal relationships and personal qualities.
interactions, particularly with other adults. Ms. As constella- Next, we follow Step 3 of the MSIA approach, in which we
tion of symptoms best matched the following DSM diagnoses: make cross-surface comparisons. For Ms. A, her proles are
major depressive disorder, generalized anxiety disorder, avoi- highly convergent, even in reecting her conict over separa-
dant personality disorder, and obsessivecompulsive personal- tion and connectedness. Taken together, these results paint the
ity disorder traits. Moreover, the patients psychotherapy picture of a woman who desires assertiveness and connection
revealed that not only was avoidance a prominent, enduring (as reported to her therapist), but feels incapable of achieving
theme throughout her life, but also underlying this behavior them and does not appear to value them. She is very sensitive
456 DAWOOD AND PINCUS

Table 3. Ms. As Treatment Outcome Package (TOP) scores over the course of therapy.

DEPRES LIFEQ MANIC PANIC PSYCS SA SCONF SEXFN SLEEP SUICD VIOLN WORKF

Preinterpersonal assessment
Intake 1 5.00 2.80 .43 5.77 2.88 2.22 1.42 3.30 3.86 3.72 .97 .11
Intake 2 5.15 2.80 .95 4.89 3.61 .34 .46 3.30 3.49 4.66 .28 1.30
Session 1 4.06 2.16 .19 2.41 N/A N/A .87 3.34 1.22 N/A N/A N/A
Session 2 3.44 2.80 .11 1.23 .63 N/A 2.05 N/A 2.49 N/A .28 .50
Session 3 4.89 2.85 .66 4.04 1.70 .34 3.74 .80 4.63 .92 .28 1.12
Session 4 5.15 3.38 .78 5.98 2.94 .34 4.77 .80 4.63 1.85 .28 .31
Session 5 4.84 3.38 .66 1.59 .87 .34 2.09 .80 1.22 .92 .28 1.12
Session 6 3.90 3.06 .05 3.29 1.32 .34 1.12 .80 2.06 .92 .28 1.12
Session 7 3.45 2.48 .22 2.63 .63 .34 .05 .56 1.52 1.63 .28 1.12
Session 8 3.17 1.06 .22 3.81 3.74 .34 2.23 .80 2.99 1.85 .28 1.12
Session 9 4.02 1.90 .48 3.04 .63 .34 1.43 .80 1.86 .70 .28 1.12
Session 10 1.05 1.90 .31 1.59 .39 N/A 1.15 N/A 2.19 .03 .28 1.12
Session 11 2.63 1.64 .18 2.70 .39 .34 1.15 .80 1.56 .20 .28 .60
Session 12 .33 1.58 .57 1.27 .11 .34 1.15 .80 .08 .25 .28 .28
Session 13 .07 1.00 .74 4.54 .13 .34 .74 N/A .08 .20 .28 1.12
Session 14 .06 1.63 .74 .15 .13 .34 1.15 .80 .75 .03 .28 .80
Session 15 .18 1.26 .74 1.50 .13 .34 .80 N/A .08 .33 N/A .16
Session 16 .09 1.00 .88 .62 .41 .34 1.15 .80 1.06 .20 .28 .81
Session 17 .07 .21 .92 4.34 .65 .34 1.15 .80 .43 .20 .28 .08
.78 .62 .65 .34 1.15 .80 1.06 .20 .28 .08
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Session 18 .05 .09


Session 19 3.11 1.16 N/A 4.97 6.38 N/A 5.11 N/A 3.53 N/A N/A N/A
Session 20 .67 .47 .58 1.61 .39 .34 1.10 .80 1.22 .20 .28 .08
Session 21 1.61 .47 .55 1.59 .65 .34 .37 .80 1.06 .25 .28 1.17
Session 22 .63 .43 .92 .28 .65 .34 .35 .80 1.06 .20 .28 .08
Session 23 .45 .74 N/A 1.24 N/A N/A N/A N/A 1.22 N/A N/A 1.34
Session 24 .07 .43 .39 1.61 .63 .34 1.15 .80 .88 .20 .28 1.08
Session 25 .76 .70 1.05 .21 .65 .34 .76 .80 .76 .20 .28 .23
Session 26 .69 .72 .92 .62 .65 .34 1.15 .80 1.06 .20 .28 1.14
Session 27 .11 2.53 .88 .15 .41 .34 1.15 .80 .40 .03 .28 1.37
Sessions 127 avg. 1.72 1.40 .30 1.96 .63 .34 .41 .53 1.01 .34 .28 .16
Postinterpersonal assessment
Session 28 .46 .43 1.05 .62 .65 .34 .35 .80 1.06 .20 .28 1.12
Session 29 .75 1.90 1.19 .62 .37 .34 1.15 .80 .22 .20 .28 .85
Session 30 .62 .74 1.05 .62 .65 .34 .37 .80 .09 .20 .28 .59
Session 31 .76 .74 .88 .62 .41 .34 1.15 .80 .06 .20 .28 1.12
Session 32 .48 .11 .92 .62 .65 .34 .04 .80 .73 .20 .28 .33
Session 33 .73 1.00 1.19 .26 .65 .34 .02 .80 1.06 .20 .28 1.17
Session 34 .46 .09 1.05 .62 .65 .34 1.15 .80 .73 .20 .28 1.44
Session 35 .76 .43 1.05 .62 .65 .34 .76 .80 1.06 .20 .28 .20
Session 36 .10 .43 .68 .62 .18 .34 .35 .80 2.06 .20 .28 .57
Session 37 .90 .43 1.05 .62 .65 .34 .76 .80 1.06 .20 .28 1.12
Session 38 .62 .43 1.05 .62 .65 .34 .76 .80 1.06 .20 .28 .50
Session 39 .78 .74 1.19 .62 .65 .34 1.15 .80 1.06 .20 .28 1.12
Session 40 .62 .43 1.05 .21 .65 .34 1.15 .80 .20 .20 .28 .85
Session 41 .90 .17 1.05 .62 .65 .34 1.15 .80 .43 .20 .28 .25
Sessions 2841 avg. .64 .17 1.03 .57 .55 .34 .74 .80 .45 .20 .28 .11

Note. DEPRES D depression; LIFEQ D life quality; PSYCS D psychosis; SA D substance abuse; SCONF D social conict; SEXFN D sexual functioning; SUICD D suicidal idea-
tion; VIOLN D violence; WORKF D work functioning. Degrees of shading indicate severity level of symptoms such that the light gray box D mild; dark gray box D mod-
erate; and the black box D severe. Negative values indicate strengths. A high value is problematic (e.g., a high LIFEQ score indicates low quality of life).

to others affection and antagonism, feels she gives too much of that she wanted her voice to be heard by others. Indeed, this
herself, and yet is often withdrawn and passive. These conict- incongruency led the therapist to pose the following questions:
ing feelings, sensitivities, values, and behaviors likely frustrate What does it mean to the patient to be an assertive person if
her agentic and communal interpersonal goals (Horowitz, she does not value it? Why does the patient feel incapable of
2004) and contribute to ongoing dissatisfaction with herself being assertive? Does the patient have certain automatic
and life. thoughts or beliefs about assertiveness? After further clarica-
tion, the therapist learned that Ms. A conceptualized assertive-
ness as being hostile and aggressive, which helped explain the
Linking Ms. As interpersonal data with CBT interventions
discrepant results.
The ndings just discussed were presented to Ms. A in a feed- Moreover, new CBT interventions were implemented
back session. She and her therapist collaboratively worked based on the patients MSIA results. For instance, the thera-
together to better understand her results in the context of her pist spent several sessions focusing on agentic functioning,
symptoms and long-standing difculties. For instance, Ms. A specically reducing the patients submissiveness (HI) and
was surprised that her scores on the CSIV indicated she did not increasing her dominance (PA) by providing Ms. A with
value assertiveness, as she frequently expressed to her therapist psychoeducation on assertiveness and teaching her how to
MULTISURFACE INTERPERSONAL ASSESSMENT 457

inept. These various CBT interventions were implemented


from Sessions 28 to 41. As illustrated in Table 3 (postinter-
personal assessment), Ms. As life quality improved dramati-
cally throughout this period after applying these specic
interventions that targeted her interpersonal difculties and
dynamics.
In summary, it is clear that Ms. A beneted from notable
symptom reductions based on CBT. Although Mr. B did
not show the same gains as Ms. A, the data suggest that his
overall quality of life did improve relative to baseline, par-
Figure 5. Interpersonal structural summary proles for Ms. A. Note. IIPSC D ticularly when his therapist no longer structured the therapy
Inventory of Interpersonal ProblemsShort Circumplex; IPIPIPC D International sessions around DBT homework and exercises (yet the
Personality Item PoolThe Interpersonal Circumplex; CSIE D Circumplex Scales of patient continued to apply DBT skills outside of the therapy
Interpersonal Efcacies; CSIV D Circumplex Scales of Interpersonal Values; ISC D
Interpersonal Sensitivities Circumplex; IIS D Inventory of Interpersonal Strengths; room of his own accord). Mr. Bs initial difculty comply-
IIPSC PA D assured-dominant; IIPSC BC D arrogant-calculating; IIPSC DE D ing with homework assignments is likely linked to his exter-
cold-hearted; IIPSC FG D aloof-introverted; IIPSC HI D unassured-submissive; nalizing (Cluster B) personality pathology; thus, a less
IIPSC JK D unassuming-ingenuous; IIPSC LM D warm-agreeable; IIPSC NO D
gregarious-extraverted; IPIPIPC PA D domineering; IPIPIPC BC D vindictive; structured approach provided him the space to resist less
IPIPIPC DE D cold-hearted; IPIPIPC FG D socially-avoidant; IPIPIPC HI D nonas- when he no longer perceived the therapist as telling him
sertive; IPIPIPC JK D exploitable; IPIPIPC LM D overly nurturant; IPIPIPC NO D
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what to do. Later in therapy, Mr. B noted that the shift in


intrusive; CSIE PA D dominant; CSIE BC D dominant and distant; CSIE DE D distant;
CSIE FG D yielding and distant; CSIE HI D yielding; CSIE JK D yielding and friendly; his attitude also came when he nally understood that the
CSIE LM D friendly; CSIE NO D dominant and friendly; CSIV PA D agentic; CSIV BC benets of doing the DBT skills exercises were for him
D agentic and separate; CSIV DE D separate; CSIV FG D submissive and separate; rather than for the therapist.
CSIV HI D submissive; CSIV JK D submissive and communal; CSIV LM D communal;
CSIV NO D agentic and communal; ISC PA D sensitive to control; ISC BC D sensi-
tive to antagonism; ISC DE D sensitive to remoteness; ISC FG D sensitive to timid-
ity; ISC HI D sensitive to passivity; ISC JK D sensitive to dependence; ISC LM D Discussion
sensitive to affection; ISC NO D sensitive to attention-seeking; IIS PA D lead; IIS BC
D direct; IIS DE D balance; IIS FG D restrain; IIS HI D cooperate; IIS JK D consider; The aim of this article was to demonstrate how multisurface
IIS LM D connect; IIS NO D engage. IPC assessment of interpersonal dynamics of personality can
augment therapy (here, CBT). This is the rst article to provide
implement assertive skills (Mu~ noz et al., 2000), including specic guidelines to help clinicians examine and interpret
active listening, I statements, and ways to rmly express patients multisurface circumplex proles. We illustrated this
her feelings to others. The therapy also targeted Ms. As approach using two brief clinical case examples. The cases also
social avoidance (FG) and conicts with warmth (LM), illustrate many unique advantages that interpersonal assess-
helping her develop a better understanding of why she feels ment offers to both the patient and therapist. For instance, a
uncomfortable and anxious in social situations, increasing detailed feedback session is useful for helping patients identify
her opportunities for social interactions, and taking part in their own interpersonal dynamics and begin to address them in
social skills training (e.g., modeling, role playing). These and out of session (Hopwood, 2010; Pincus, Sadler, et al., 2014;
treatment approaches, in turn, provided additional occa- Hopwood et al., in press). Feedback sessions with both Ms. A
sions for Ms. A to identify and challenge her cognitive dis- and Mr. B gave them a sense of curiosity about themselves and
tortions and core beliefs, such as feeling she is socially encouraged patient buy-in to recommended interventions

Table 4. IPC measure scale scores and structural summary parameters for Ms. As assessment.
Standardized scale scores Structural summary

PA (90 ) BC (135 ) DE (180 ) FG (225 ) HI (270 ) JK (315 ) LM (0 ) NO (45 ) e a Q R2

Efcacies (CSIE) 2.82 2.73 1.51 1.86 1.29 1.13 .13 1.25 .52 2.31 281.84 .91
Traits (IPIPIPC) 1.25 1.49 .07 1.80 1.16 .79 1.89 2.49 .04 1.72 279.52 .66
Problems (IIPSC) .02 .06 2.16 2.85 2.55 1.89 3.07 1.28 1.40 1.72 264.76 .65
Sensitivities (ISC) .04 .98 .02 2.10 .34 .16 2.12 .56 .01 .81 42.71 .26
Values (CSIV) .05 1.24 1.29 2.36 .97 1.69 .66 .75 .45 2.31 248.64 .68
Strengths (IIS) 1.51 1.63 1.55 2.03 3.09 1.20 1.57 .59 1.65 .66 60.53 .49

Note. IPC D The Interpersonal Circumplex; e D elevation; a D amplitude; Q D angular displacement; CSIE D Circumplex Scales of Interpersonal Efcacies; IPIPIPC D
International Personality Item PoolIPC; IIPSC D Inventory of Interpersonal ProblemsShort Circumplex; ISC D Interpersonal Sensitivities Circumplex; CSIV D Circum-
plex Scales of Interpersonal Values; IIS D Inventory of Interpersonal Strengths; CSIE PA D dominant; CSIE BC D dominant and distant; CSIE DE D distant; CSIE FG D
yielding and distant; CSIE HI D yielding; CSIE JK D yielding and friendly; CSIE LM D friendly; CSIE NO D dominant and friendly; IPIPIPC PA D domineering; IPIPIPC BC
D vindictive; IPIPIPC DE D cold-hearted; IPIPIPC FG D socially-avoidant; IPIPIPC HI D nonassertive; IPIPIPC JK D exploitable; IPIPIPC LM D overly nurturant; IPIP
IPC NO D intrusive; IIPSC PA D assured-dominant; IIPSC BC D arrogant-calculating; IIPSC DE D cold-hearted; IIPSC FG D aloof-introverted; IIPSC HI D unassured-
submissive; IIPSC JK D unassuming-ingenuous; IIPSC LM D warm-agreeable; IIPSC NO D gregarious-extraverted; ISC PA D sensitive to control; ISC BC D sensitive to
antagonism; ISC DE D sensitive to remoteness; ISC FG D sensitive to timidity; ISC HI D sensitive to passivity; ISC JK D sensitive to dependence; ISC LM D sensitive to
affection; ISC NO D sensitive to attention-seeking; CSIV PA D agentic; CSIV BC D agentic and separate; CSIV DE D separate; CSIV FG D submissive and separate; CSIV HI
D submissive; CSIV JK D submissive and communal; CSIV LM D communal; CSIV NO D agentic and communal; IIS PA D lead; IIS BC D direct; IIS DE D balance; IIS FG D
restrain; IIS HI D cooperate; IIS JK D consider; IIS LM D connect; IIS NO D engage.
458 DAWOOD AND PINCUS

targeting specic difculties. This likely enhanced the therapeu- information, uniquely assessed by the ISC, is important
tic relationship, which is important to the success of psycho- because it suggests a necessary treatment target prior to
therapy (Norcross, 2002). behavioral assignments aimed at increasing social interac-
An MSIA combined with a feedback session also has the tions with others. If this interpersonal sensitivity is not
advantage of allowing patients to learn something new about addressed, it could prove difcult to motivate patients to
themselves or make explicit and bring to the surface those actively pursue more connectedness with others and
unspoken thoughts, feelings, beliefs, and values the patient improve relational functioning. For example, discussion
might have difculty communicating to the therapist. For with Ms. A helped clarify that she was bothered by others
example, Ms. A learned that she misunderstood the meaning of warmth not because she did not want to connect with
assertiveness and this likely played a part in her difculty voic- them, but for the fear that the other person would eventu-
ing her needs, wants, and wishes to others. On the other hand, ally reject her and hurt her emotionally. As such, the
Mr. Bs experience of the feedback of his interpersonal results patient found it easier to behave passively and avoid others
was mind-blowing not because he learned something new rather than assert herself and risk rejection. In contrast, Mr.
about himself, but rather for hearing the therapist reect back B expressed being bothered by others affection because he
to him the very thoughts he found himself unable to verbalize was suspicious that others who were kind toward him had
in sessions, particularly those that exposed his vulnerable side ulterior motives, perpetuating his fear that others would
(e.g., his desire for closeness with others). exploit him. Thus, Mr. B found it easier to be standofsh
Moreover, assessing interpersonal dynamics expands the from others, avoid them all together, or lash out. In these
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scope of treatment by providing an important context for ways, the assessment of interpersonal sensitivities tapped
understanding a patients symptoms, complaints, and function- unique aspects of the clients issues that informed future
ing beyond psychiatric diagnoses (Cain et al., 2012; Przeworski interventions.
et al., 2011). Indeed, many clinicians want to know who a In this study, we demonstrated that the MSIA approach pro-
patient is, in addition to what categories his or her symptoms motes therapistclient collaboration and enhances case concep-
match, as this plays a signicant role in guiding a clinicians tualization, treatment planning, clinical decision making, and
focus and type of intervention (McWilliams, 1999, 2011). An intervention. A main limitation to these case presentations is
MSIA offers one viable, inexpensive, and clinically useful that we were unable to examine whether our patients scores on
means to better understanding the whole person. the multisurface IPC proles changed over time, as we did not
Interpersonal assessment data can also help organize clinical have repeated MSIAs on these patients. This is an area that
case formulations (e.g., Hopwood et al., in press), as well as would certainly benet from further attention and could be eas-
identify specic targets for interventions (Cain & Pincus, 2015; ily incorporated into ongoing treatments, allowing the clinician
Erickson, Newman, & McGuire, 2015). Although a standard- to track therapeutic change in the patients interpersonally
ized psychopathology assessment and a CB case formulation informed treatment goals. Another direction for future studies
approach (Persons, 1989) proved useful in helping guide initial is to develop empirical methods and standards for quantifying
interventions that addressed patients psychological symptoms the magnitude of consistencies and discrepancies in multisur-
(e.g., depression, panic, sleep disturbance), an MSIA approach face IPC proles, as currently there is no accepted convention.
proved useful in guiding other interventions to address the Although this has been a relatively neglected topic in assess-
patients chronic dissatisfaction with themselves and their life ment research (but see Benjamin, 1984, 1994), the literature is
beyond symptom reduction. Because a patient might not be rich with theoretical models, therapeutic approaches, and case
aware of certain contradictions in the self, an MSIA can help studies describing the clinical importance of examining both
shed light on those blind spots that might not have been taken interpersonal and intrapsychic conicts. Ultimately, we hope
into account in a CB formulation. This could open up places that this article will encourage both emerging and seasoned
for further exploration, and understanding and addressing con- clinicians to incorporate MSIA in clinical practice.
tradictory aspects of the self might lead to gradual cohesion of
the patients personality. For instance, the fact that Ms. As
scores on the CSIV did not parallel her report of wanting her References
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