The Shedler–Westen Assessment Procedure (SWAP): Making Personality Diagnosis Clinically Meaningful

Department of Psychiatry, University of Colorado Health Sciences Center, Denver, CO 80220, USA.
Journal of Personality Assessment (Impact Factor: 2.01). 08/2007; 89(1):41-55. DOI: 10.1080/00223890701357092
Source: PubMed

ABSTRACT There is a schism between science and practice in understanding and assessing personality. Approaches derived from the research laboratory often strike clinical practitioners as clinically naive and of dubious clinical relevance. Approaches derived from clinical observation and theory often strike empirical researchers as fanciful speculation. In this article, we describe an approach to personality designed to bridge the science-practice divide. The Shedler-Westen Assessment Procedure (SWAP; Shedler & Westen, 2004a, 2004b; Westen & Shedler, 1999a, 1999b) is an empirically rigorous diagnostic method that preserves the richness and complexity of clinical case description. In this article, we describe its use in diagnosis, case conceptualization, and treatment planning. We review evidence for reliability, validity, and clinical utility. Finally, in the article, we present a system for personality diagnosis, as an alternative to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) Axis II, that is empirically grounded, clinically relevant, and practical for routine use in both clinical and research contexts.

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    • "In our study , due to our a priori hypothesis on the narcissistic and depressive - anaclitic nature of depres - sion , we concentrated the analyses on the SWAP results showing the narcissistic and the disphoric dimensional styles . The narcissistic style in fact reflects a more self - centered atti - tude on the part of the patient toward the conflict evoked by her new status as mother , while the dysphoric style reflects her attitude toward loss and attachment ( Shedler and Westen , 2007 ) . "
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    ABSTRACT: Oxytocin is a neuropeptide that is active in the central nervous system and is generally considered to be involved in prosocial behaviors and feelings. In light of its documented positive effect on maternal behaviour, we designed a study to ascertain whether oxytocin exerts any therapeutic effects on depressive symptoms in women affected by maternal postnatal depression. A group of 16 mothers were recruited in a randomized double-blind study: the women agreed to take part in a brief course of psychoanalytic psychotherapy (12 sessions, once a week) while also being administered, during the 12-week period, with a daily dose of intranasal oxytocin (or a placebo). The pre-treatment evaluation also included a personality assessment of the major primary-process emotional command systems described by Panksepp (1998) and a semi-quantitative assessment by the therapist of the mother’s depressive symptoms and on her personality. No significant effect on depressive symptomatology was found following the administration of oxytocin (as compared to a placebo) during the period of psychotherapy. Nevertheless, a personality trait evaluation of the mothers, conducted in our overall sample group, showed a decrease in the narcissistic trait only within the group who took oxytocin. The depressive (dysphoric) trait was in fact significantly affected by psychotherapy (this effect was only present in the placebo group so it may reflect a positive placebo effect enhancing the favorable influence of psychotherapy on depressive symptoms) but not in the presence of oxytocin. Based on these results, we confirm our hypothesis that what is generally defined as postnatal depression may include disturbances of narcissistic affective balance, and oxytocin supplementation can counteract that type of affective disturbance.
    Frontiers in Psychology 04/2015; 6:426. DOI:10.3389/fpsyg.2015.00426 · 2.80 Impact Factor
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    • "Rosch & Mervis, 1975). Card sort research is used in a wide range of scientific disciplines, including psychiatry and clinical psychology (e.g., Block, 1961; Iwamasa, Larrabee, & Merritt, 2000; Davidson, Obonsawin, Seils, & Patience, 2003; Fowler & Lilienfeld, 2007; Shedler & Westen, 2007). As discussed above, research using CFA of prototypicality ratings has provided some support for the validity of CAPP domains . "
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    ABSTRACT: This study examines the structure of the Comprehensive Assessment of Psychopathic Personality (CAPP) from a card sort perspective. The CAPP is a lexically based construct map of psychopathy comprising 33 symptoms organized by its developers into 6 broad functional domains of personality (i.e., Attachment, Behavioral, Cognitive; Dominance; Emotional, Self). Groups of mental health workers and students were asked to sort the CAPP symptoms into the model's 6 proposed domains. Overall, both mental health workers and students were able to categorize the symptoms speedily and intuitively according to model. This suggests that the CAPP model's hierarchical structure is plausible, and that the lexical nature of the model is successful in facilitating people's ability to understand features of psychopathy in a way that requires limited cognitive effort. Together, these findings support the validity of the CAPP model as a lexically based concept map of psychopathy. Yet, some exceptions to the overall pattern of agreement with model were identified. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Personality Disorders: Theory, Research, and Treatment 04/2015; 6(2):117-128. DOI:10.1037/per0000111 · 3.54 Impact Factor
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    • "We hypothesized that the AAI, the AAP, the SCL-90-R, and the SWAP–200 would help in focusing on the most relevant dimensions of patient’s psychological functioning which make a meaningful diagnosis (Barron, 1998; Shedler and Westen, 2007) at the beginning and at the end of treatment. Attention was directed to the interplay between modification of overt symptoms and behaviors, and changes in personality functioning and adaptation; more specifically, we focused on patterns and complexities in the patient’s internal organization and interpersonal functioning (Shectman and Harty, 1986; Peebles-Kleiger, 2002; Bram, 2010). "
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    ABSTRACT: There is a gap between proposed theoretical attachment theory frameworks, measures of attachment in the assessment phase and their relationship with changes in outcome after a psychodynamic oriented psychotherapy. Based on a clinical case study of a young woman with Panic Attack Disorder, this paper examined psychotherapy outcome findings comparing initial and post-treatment assessments, according to the mental functioning in S and M-axis of the psychodynamic diagnostic manual. Treatment planning and post-treatment changes were described with the main aim to illustrate from a clinical point of view why a psycho-dynamic approach, with specific attention to an "attachment theory stance," was considered the treatment of choice for this patient. The Symptom Check List 90 Revised (SCL-90-R) and the Shedler-Westen Assessment Procedure (SWAP-200) were administered to detect patient's symptomatic perception and clinician's diagnostic points of view, respectively; the Adult Attachment Interview and the Adult Attachment Projective Picture System (AAP) were also administered as to pay attention to patient's unconscious internal organization and changes in defense processes. A qualitative description of how the treatment unfolded was included. Findings highlight the important contribution of attachment theory in a 22-month psychodynamic psychotherapy framework, promoting resolution of patient's symptoms and adjustment.
    Frontiers in Psychology 08/2014; 5:912. DOI:10.3389/fpsyg.2014.00912 · 2.80 Impact Factor
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