John H. Porcerelli

University of Detroit Mercy | UDM · Doctoral Program in Clinical Psychology

Karliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a su...

The Covid-19 pandemic challenged individuals in several different ways and required a number of interpersonal adjustments. Object-Relations theory argues that one’s capacity to adjust adaptively to changing interpersonal contexts is impacted by one’s degree of self-other differentiation. Similarly, attachment theory suggests that one’s attachment s...

The Covid-19 pandemic required individuals to make numerous life adjustments and deal with a wide range of stressors. Psychoanalytic theory would assert that individuals’ capacity to adaptive adjust to these stressors would be dependent, in part, on their ability to employ adaptive psychological defenses to manage their distress. The purpose of the...

This investigation examined links between three related personality styles as assessed with the Relationship Profile Test—destructive overdependence, dysfunctional detachment, and healthy dependency—and indices of health and health-related behavior in a mixed-sex (74% female) sample of 100 primary care patients with a mean age of 38.62 (SD = 12.99)...

This article memorializes Phebe K. Cramer (1936-2021). Phebe K. Cramer was a consummate researcher, clinician, administrator, and athlete. Her most notable contribution as a psychologist was the creation and validation of a model of defense mechanism development and 30+ years of experimental, longitudinal, and cross-sectional research providing emp...

Research shows that the subscales of the Relationship Profile Test (RPT) are related to adult attachment. Gender differences have been implicated, but findings are inconsistent in terms of replication. A limited amount of research has been conducted on ethnic differences in the context of interpersonal dependency. This study aims to bridge the gap...

The objective of this study was to assess changes in maternal defensive functioning from the third trimester of pregnancy to 2 years postpregnancy. A community sample of at-risk mothers (N = 84; non-White [61%], unmarried [67%], high school or less education [72%], and income less than $20,000 [50%]) were recruited for this longitudinal study. Moth...

Over the last decade, there has been a major paradigm shift in the way researchers and clinicians conceptualize and assess personality pathology (e.g., Herpertz et al., 2017; Waugh, 2019). New diagnostic systems have been developed (e.g., Alternative Model of Personality Disorders [AMPD; APA, 2013] and the Psychodynamic Diagnostic Manual, 2nd Editi...

Primary care practice has become a rapidly evolving and increasingly important facet of modern medicine. In the context of greater availability of primary care services and integrated care models, it is important to recognize and address the factors and potential barriers that affect compliance with treatment and positive patient experience and out...

Defense mechanisms are unconscious mental processes which modify or distort one's thoughts, feelings, or experience of reality to protect against anxiety associated with internal and external stressors. A concept which originated in Sigmund Freud's drive theory, the principles and implications of defense mechanisms on psychological functioning have...

This study aims to assess whether mothers reporting high and low child abuse potential differ in their experiences of childhood abuse and use of defense mechanisms, and to examine factors which might predict child abuse potential. 120 pregnant mothers in their third trimester completed demographic questionnaires, trauma and abuse potential measures...

Purpose To examine the nature and severity of impaired self-awareness (ISA) and denial of disability (DD) in a community-dwelling traumatic brain injury (TBI) population. Additionally, to investigate reliability, internal consistency, and feasibility of the Clinician’s Rating Scale for evaluating Impaired Self-Awareness and Denial of Disability aft...

Although childhood victimization is associated with impairments in object relations, it is not clear how different measures comparatively perform in assessing this relationship. This study examined the connection between emotional, physical, and sexual abuse in childhood and three methods of assessing malevolent object representations. Sixty adult...

In an attempt to operationalize an implicit aspect of the therapeutic alliance, this article proposes the use of the innovative, objective, and time-efficient analysis of language style matching (LSM; Niederhoffer & Pennebaker, 2002). LSM, defined as the degree of similarity in rates of function words in dyadic interactions, is thought to reflect t...

Defense mechanisms are mental functions which facilitate coping when real or imagined events challenge personal wishes, needs, and feelings. Whether defense mechanisms have a specific neural basis is unknown. The present research tested the hypothesis that interhemispheric integration plays a critical role in defense mechanism development, by study...

Healthcare in the United States has increasingly benefited from the adoption of multidisciplinary providers. Many multidisciplinary teams include psychologists who often conduct psychological and personality assessments in their practice. This special section highlights areas of personality and psychological assessment in applied healthcare context...

This study evaluated the Social Cognition and Object Relations Global Rating Method (SCORS-G; Stein, Hilsenroth, Mulford, & Pinkser, 2011; Stein and Mulford, 2018 ; Westen, 1995 ) and the Bell Object Relation and Reality Testing Inventory (BORRTI; Bell, 1995 ) to determine the extent to which the measures were correlated with each other and their r...

The integration of psychologists and other behavioral health providers in primary care practice continues to evolve and reshape approaches to patient care. This study is a replication and extension of a 2013 study describing dual interviewing encounters involving psychology trainees and family medicine residents within an integrated primary care cl...

In 2016, there was an estimated 671,622 victims of child abuse and neglect in the United States (U.S. Department of Health & Human Services, 2018), 18.2 percent were victims of physical abuse and 8.5 percent were sexually abused (U.S. Department of Health & Human Services, 2018). The purpose of this study was to assess whether certain defense mecha...

The diagnosis and treatment of cancer are extremely stressful and life-altering experiences that can challenge an individual's conscious and unconscious coping ability. Perry, Metzger, and Sigal (2015) studied the unconscious coping strategies (i.e., defense mechanisms) in a recently recovered group of breast cancer survivors ( N = 76) and found th...

Personality traits are strong predictors of health and health behaviors across the life span (Turiano, Hill, Graham, & Mroczek, 2018). The examination of various facets of personality, such as interpersonal dependency and pathological traits, is important to gain a deeper understanding of the constructs that contribute to health and health behavior...

A growing body of research supports the validity of the Personality Inventory for DSM-5 (PID-5) in evaluating community and psychiatric samples. Although maladaptive personality also has significant relevance in primary care settings, research on the PID-5 in primary care samples is limited. In this study, the authors examined the intercorrelations...

Heterogeneity within diagnostic types and comorbidity across diagnostic groups render a specific personality disorder anything but specific, leading researchers and clinicians to increasingly focus on the general severity of personality pathology. Personality pathology severity is reflected in one's level of personality organization (LPO) and resea...

Objective: Lifetime trauma, relationship adversities, and emotional conflicts are elevated in primary care patients with medically unexplained symptoms (MUS), and these risk factors likely trigger or exacerbate symptoms. Helping patients disclose stressors, increase awareness and expression of inhibited emotions, and link emotions to physical symp...

Research has indicated that as many as 10% to 15% of primary care patients have symptoms that are not well explained medically. These patients could be labeled as “somatizers.” This study assessed the extent to which underlying psychological characteristics contribute to a person's level of somatization and service utilization. The Social Cognition...

Influence of EI in the medical relationship

In the healthcare setting, adult patients with histories of childhood abuse are of significant concern and are frequently encountered in the primary care setting. However, there is a dearth of studies investigating the relationships between psychopathology, overall health, healthcare utilization, physician ratings of patient difficulty, and childho...

In the primary care setting, the difficult patient poses a significant problem for physicians (Groves, 1978). The literature suggests that a patient’s level of personality pathology and/or somatic symptom severity may be predominant contributors to physician’s rating a patient as difficult (Schafer & Nowlis, 1998; Hahn, et al., 1994). However, rela...

A group of 49 patients who had been diagnosed with cancer during the preceding year and who were receiving radiation therapy were assessed for their use of defense mechanisms, as well as for their level of psychological distress. In addition, their utilization of medical services was determined. It was predicted that the use of services that were u...

Individuals with Borderline Personality Disorder (BPD) are often seen as “difficult” patients within primary health care settings (Sansone & Sansone, 2004). Awareness of BPD features or diagnosis by primary care physicians helps them to develop management strategies (e.g., appropriate limit setting) in order to provide appropriate medical care for...

This article will provide a description of defense mechanisms; a brief history of defenses beginning with the work of Sigmund Freud; the motivating factors behind defense use; an overview of the more commonly used defenses; the relationship between defenses and psychopathology; the development of defenses in children, adolescents, and young adults;...

The outcomes of psychoanalysis, as with other psychotherapies, vary considerably. Psychoanalytic Treatment in Adults examines the results of a longitudinal study of change during psychoanalysis, illuminating the characteristics of patients, analysts and analyses which can help to predict outcomes of treatment. Written by experienced psychologists a...

Ongoing research presentation/discussion

Research Seminar Discussion

In this article, we provide a historical overview of the Object Relations Inventory (ORI) and related methods for the assessment of object relations constructed by Sidney Blatt and colleagues (e.g., Blatt, Bers, & Schaffer, 199224. Blatt, S. J., Bers, S. A., & Schaffer, C. E. (1992). The assessment of self. Unpublished research manual, Yale Univers...

This study assessed the relationship between psychopathology with the Personality Assessment Screener (PAS) and childhood physical and sexual abuse and adult physical and sexual partner violence in a primary care sample of 98 urban-dwelling African American women. Patients completed the PAS, the Childhood Trauma Questionnaire, and the Conflict Tact...

Objective: For at-risk (single parent, low income, low support) mothers, healthy adaptation and the ability to manage stress have clear implications for parenting and the social-emotional well-being of their young offspring. The purpose of this longitudinal study was to examine associations between defense mechanisms in pregnant women and their to...

Background: The Kalamazoo Essential Elements Communication Checklist-Adapted (KEECC-A) is a well-regarded instrument for evaluating communication and interpersonal skills. To date, little research has been conducted that assesses the accuracy of resident self-ratings of their communication skills. Objective: To assess whether residents can accur...

The Assessment of Qualitative and Structural Dimensions of Object Representations assessment instrument (AOR; Blatt, Chevron, Quinlan, Schaffer, & Wein, 199210. Blatt, S. J., Chevron, E. S., Quinlan, D. M., Schaffer, C. E., & Wein, S. (1992). The assessment of qualitative and structural dimensions of object representations—Revised edition. Unpublis...

Personality traits have been associated with positive and negative adjustment to a cancer diagnosis. No studies have assessed trait dependency and detachment and their relationship to health, distress, and the doctor-patient relationship in patients undergoing radiation treatment for cancer. Fifty adults (32 women; mean [SD], 60.32 [12.74] years) u...

Although stress is linked to mental and physical health, self-reports of stress may be operationalized using measures that emphasize cognitive appraisals of stressors or that simply record stressor exposure. Theory and research suggest that appraisal-based measures may be superior in measuring self-reports of stress. Yet, use of exposure-based meas...

In this article, we provide a response to Kyle Arnold's paper, "Intellectualization and Its Lookalikes." We provide a general review of the empirical literature on the study of the defense of intellectualization. We highlight the paucity of empirical findings on this topic, though note that the extant findings do provide some support for the utilit...

This study assessed the validity of the Patient-Doctor Relationship Questionnaire-9 (PDRQ-9) in a primary care sample (N = 180). Convergent validity was assessed through a correlation between the patient-rated PDRQ-9 and the physician-rated Difficult Doctor Patient Relationship Questionnaire-10 (DDPRQ-10). Discriminant validity was assessed through...

This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program. The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between f...

Individuals with posttraumatic stress disorder (PTSD) symptoms engage in greater rates of health care utilization. Existing literature is limited, however, because the number of visits to health care providers is exclusively used as an outcome. Low-income women (N = 96) screening positive for PTSD symptoms (n = 23; 23.9%) were compared to those who...

In this cross-sectional study, we compare the Shedler-Westen Assessment Procedure (SWAP) Insight Scale scores in three groups of psychoanalytic patients. Psychoanalysts completed the SWAP to describe a real patient at the beginning of analysis, a real patient at the end of analysis, or a hypothetical ideal patient at the end of a successful analysi...

BACKGROUND AND OBJECTIVES: Family medicine residents increasingly work collaboratively with psychology trainees. One type of collaborative experience involves dual interviewing of clinic patients. The goal of this observational study was to provide an initial description of what occurs during dual interviews as it relates to behavioral health asses...

Screening for psychosocial problems is an effective way to identify children who need further evaluation, and many brief, psychometrically strong measures exist for this purpose. More research is needed, however, about the performance of these measures in special populations who are familiar to primary care settings. The purpose of this study was t...

Background: Medical interactions between Black patients and non-Black physicians are less positive and productive than racially concordant ones and contribute to racial disparities in the quality of health care. Objective: To determine whether an intervention based on the common ingroup identity model, previously used in nonmedical settings to r...

To assess the test-retest reliability of the Shedler-Westen Assessment Procedure-200 (SWAP-200) personality disorder, high functioning, and Q-factor (trait/symptom) scales, we correlated the reports of 47 psychoanalysts describing a patient at the beginning of analysis and at 6 months of analysis. Since the length of psychoanalysis averages almost...

The diagnostic efficiency of the Personality Assessment Screener (PAS; Morey, 1997) total score was evaluated using selected scales from the Patient Health Questionnaire (Spitzer, Kroenke, & Williams, 1999), the fourth edition of the Personality Diagnostic Questionnaire (Hyler, 1994), and the Alcohol Use Disorders Identification Test (Saunders, Aas...

Recent consensus guidelines have recommended uniformity in procedural training in family medicine residency programs. The consensus documentation suggestions are based on expectations of procedural training prior to residency. Few studies have evaluated the perceived baseline level of procedural competency prior to residency training. Twenty incomi...

Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention and poor outcome. One explanation for drop-out is weak treatment alliances. A single-case experimental analysis accompanied by in-depth qualitative description is presented for Ms. O, who received a novel treatment for AN called Alliance Fo...

We describe the assessment of a troubled adolescent boy to demonstrate the use of the Shedler–Westen Assessment Profile for Adolescents (Westen, Dutra, & Shedler, 200526. Westen , D. , Dutra , L. and Shedler , J. 2005. Assessing adolescent personality pathology. British Journal of Psychiatry, 186: 227–238. View all references) and the Social Cog...

Pulmonary lymphangitic carcinomatosis (PLC) is a metastatic lung disease characterized by the lymphangitic spread of the cancer cells to the pulmonary vasculature and lymphatics. We describe a case of a 49 year old woman who presented with dyspnea, cough and weight loss. Surgical lung biopsy revealed metastatic adenocarcinoma with lymphangitic carc...

We present the case of a multidisciplinary primary care assessment of a 32-year-old woman with multiple medical and psychological complaints. Following the collaborative care model, this assessment was conducted by a team consisting of a clinical health psychologist, Dr. J. L. Skillings, and a family physician, Dr. W. J. Murdoch. We describe the pr...

In an attempt to illustrate the relevance of psychoanalytic theory and research to behavior medicine, an empirical investigation was conducted of females treated at a high-risk pregnancy specialty clinic (N = 58). Drawing from psychoanalytic object relations theory, it was hypothesized and confirmed that use of projection as a defense mechanism dur...

We examined the convergent validity of Cramer’s Defense Mechanisms Manual (DMM; Cramer, 1991b) by comparing it to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 19941. American Psychiatric Association. 1994. Diagnostic and statistical manual of mental disorders , 4th ed., Washington, DC: Author...

Adult and childhood sexual and physical abuse are common and intertwined. Our objectives were to assess (1) the relationship between different forms of abuse; (2) outpatient charges and hospital and emergency department use among women with and without childhood and adult abuse; (3) psychiatric symptoms of women with and without childhood and adult...

Psychoanalytic theories describe defense mechanisms and object relations as psychological structures that have functions vital to personality regulation. In theory, these structures develop in stages and emerge as a coordinated, stable system in early adulthood. However, different levels of maturity of systemic function predominate in various indiv...

This case study is based upon data from a male patient with Avoidant Personality Disorder who was in psychoanalytic treatment for 5 years. Defense mechanism use was assessed by 3 coders using the Defense Mechanisms Rating Scales. Session transcripts from intake, each year of therapy, and 1-year follow-up were used for the ratings. Over the course o...

The SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective, and End the encounter) Framework is a checklist-style rating scale to facilitate the teaching and assessment of communication skills in medical learners. It has been used for over 15 years, and it is recommended in the Accreditation Council for Gra...

Psychodynamic theories of panic disorder (PD) suggest an association between PD and impairments in mental representations. This study tested this hypothesis by comparing mental representations of 25 African-American women recruited from an urban primary care clinic with PD with a group of 25 women without PD and matched on race, age, marital status...

Q methodology is a combination of conceptual framework, technique of data collection, and method of analysis that collectively provides the basis for the scientific study of subjectivity. This is distinguished from R methodology, which provides the basis for the study of what is objective in human behavior. Innovated in the mid-1930s by British phy...

Studies have documented the construct validity of Bornstein and Languirand's (2003)20. Bornstein , R. F. and Languirand , M. A. 2003. Healthy dependency, New York: Newmarket Press. View all references Relationship Profile Test (RPT) in college students, psychotherapy patients, and nursing home residents, but no studies have examined the utility o...