Академический Документы
Профессиональный Документы
Культура Документы
The Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) is the first bold
step in providing an integrative, science-based, psychologically oriented in-depth ap-
proach to assessment in contrast to a medical model approach exemplified by the
Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision [DSM];
American Psychiatric Association, 2000). The PDM was developed to assess psycholog-
ical functioning without overlooking its full complexity, range, and depth. In doing so, the
person’s unique individuality and subjectivity are emphasized, and adaptive as well as
maladaptive functioning is addressed because clinical utility demands that both be taken
I acknowledge and thank Dr. Robert Gordon for his friendly encouragement and support of my
interest in the M Axis, and for his gentle, helpful suggestions in the writing of this article.
Correspondence concerning this article should be addressed to Janet Etzi, PsyD, 18 Druim
Moir Lane, Philadelphia, PA 19118. E-mail: jetzi@immaculata.edu
119
Copyrighted Material. For use only by 20021. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org).
120 ETZI
into account, in order to come up with the most effective and well-rounded therapeutic
interventions. An individual profile is developed by assessing psychological functioning
using three broad dimensions: the P Axis covers personality patterns and disorders; the M
Axis covers mental functioning or mental capacities; the S Axis integrates manifest
symptoms including a DSM diagnosis into personality and mental functioning.
Psychology’s reliance on the DSM for diagnosis has had the detrimental effect of
allowing us to think that a psychodynamic conceptualization, or perhaps any conceptu-
alization, is unnecessary for comprehensive and clinically useful assessment for the work
of psychotherapy. The DSM diagnosis has been very useful for research purposes but it
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
eventual distillation of such a vast amount of theory into a more manageable form to be
used by psychotherapists as an alternative to diagnosing with the DSM and more
important, to reintroduce conceptualization into the diagnostic process, more accurately,
the assessment process (Bornstein, 2011).
The three areas of development are understood as being situated in neurobiological
processes, which is not equivalent to reducing the mind or psyche to the brain or its
structures and functions. Rather, recent theorizing views psychological development and
by extension psychopathogenesis as the coevolution of genetically predetermined struc-
tures and functions, in tandem with the influences of the socioemotional environment,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
namely the mother–infant attachment relationship (Bowlby, 1969), including those expe-
riences lying outside of conscious awareness.
The M Axis implicitly conceptualizes the personality as the integration of nature
(temperament, genetic predisposition, innate traits) and nurture (experience, attachment
style, cultural and social context). In other words the concepts already contain the
integration of the biological and the psychological. Making this integration explicit serves
to clarify the complex nature of what is being conceptualized in each of the nine capacities
so that the work of streamlining an assessment method of such complex phenomena might
continue. The organizers of the PDM do not explicitly articulate this conceptualization.
Nowhere in the PDM does it say that personality functioning is viewed as the integration
of neurobiology and experience, but when the M Axis capacities are analyzed keeping in
mind on one hand the neurobiological structures underlying functions like affect regula-
tion, mental representations, emotional expression, and defenses (Bateman & Fonagy,
2012; Schore, 1994, 2003, 2012), and on the other hand the socioemotional environment,
namely, the attachment bond between caregiver and infant, then we can see this integra-
tion as being part of the framework with which the M Axis capacities can be thought about
and utilized.
Key to psychodynamic theory is the concept of the unconscious. The PDM represents the
conceptualization of personality functioning including what lies outside of conscious
awareness (Huprich, 2011). As in the psychoanalytic psychotherapy process where the
dual nature of consciousness is a given and part of the work and experience of both
members of the psychotherapy relationship, so in the assessment process the clinician is
at least implicitly aware of the nonconscious aspects of the subject’s psychological
functioning. Psychoanalytic psychotherapy has long understood that much of what is
communicated in therapy sessions lies outside of conscious awareness and requires the
therapist to receive it perhaps first implicitly and then come to some means of managing
it and incorporating it into what is most therapeutic about the work. Bromberg (2006)
provides vivid and illuminating examples of working with enactments in therapy and how
this work involves the therapist’s capacity to engage with the patient’s immediate
self-states. Psychotherapy patients communicate emotional stress states unconsciously or
implicitly through enactments and transference, and the therapist experiences them im-
mediately before they can be processed for therapy to proceed well. Ginot (2007)
addresses enactments in the context of recent research in neuroscience. It can be assumed
that the same kind of implicit communication takes place in the assessment process and
that the psychodynamic clinician using the PDM is at least being informed by how
unconscious/implicit aspects of personality are essential to fully understanding personality
Copyrighted Material. For use only by 20021. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org).
122 ETZI
functioning (Kernberg, 1984; Kernberg & Caligor, 2005). So the question arises, “how do
we systematically assess our patients’ range of distress, personality functioning, and
psychopathology, given the fact that much of it is processed, communicated, and received
outside of conscious awareness?” Asking this question in the context of the M Axis mental
capacities and how they might be utilized in a practical and methodical way, leads me to
a two part answer: 1) The PDM represents what we are assessing; it gives us the concepts
for operationalizing the complexity and dynamism of personality functioning and psy-
chopathology. These concepts will be delineated more specifically later in the paper. 2)
The PDM does not address how we are to go about the very complex and difficult task of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
personality assessment when we want to include both conscious and unconscious aspects.
A number of excellent assessment tools are listed in the PDM which can help to measure
components of mental and personality functioning. But without a way to make explicit the
implicit aspects of the assessment process, those aspects conveyed and received implicitly,
we lack a fully systematic way of assessing the dual nature of the self. Newton and Schore
(2012) take up the idea of building in the implicit awareness of the clinician doing
infant-mother dyad assessment.
In this approach, the assessment technique is not as important as the assessment
process. The interdisciplinary trans-theoretical lens of regulation theory can be applied to
any clinician’s understanding of how one’s subjectivity and implicit corporeal self is used
in both assessment and treatment at all stages of the life span. . .” (p. 394).
(W)hat is learned cognitively and stored in the left hemisphere has little to do with the
affective relational, two-person experiences stored in the right hemi- sphere. Clinicians
can only assess these patterns through their own implicit right brain connections with their
clients, that is, by accessing their own bodily based instinctive responses (p. 400).
Psychodynamic theory and the PDM have provided the concepts with which we can
comprehend and articulate the full range and depth of an individual’s personality func-
tioning. Psychodynamic psychotherapists directly address the dual nature of the self in the
work of psychotherapy. What is not made explicit in the PDM is how to go about
assessing the nonconsciously experienced aspects either by the subject or the clinician to
inform the work of the therapy. It may be sufficient in this regard to be aware of the
difficulties in attuning to the subject, much like awareness of intense countertransference
feelings informs us about the internal state of the subject (Kernberg, 1984). In affect
regulation theory this process is addressed by Schore.
(T)he psychobiologically attuned empathic therapist, on a moment-to-moment basis,
implicitly tracks and matches the patterns of rhythmic crescendos/decrescendos of the
patient’s regulated and dysregulated ANS with his or her own ANS crescendos/
decrescendos (pp. 93).
The moment-to-moment tracking that psychoanalytic psychotherapists are familiar
with may be applied to the assessment process to good effect. The work of standardizing
this type of assessment process still needs to be done.
Infant–Caregiver Relationship
The infant– caregiver relationship is part of the framework being utilized here to articulate
the M Axis capacities in line with psychoanalytic theory, and developmental theory more
generally. Recent research from several related disciplines clearly demonstrates the role of
the critical periods in infancy for the development of both healthy and disrupted
personality and mental functioning. In addition, recent research is highlighting the role of
Copyrighted Material. For use only by 20021. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org).
the infant– caregiver relationship on the developing mind of the infant. The self develops
only in relation to the primary caregiver(s) (Siegel, 1999). Personality is the internalized
enduring legacy of the early infant– caregiver relationship.
The theories of Allan Schore (1994, 2003, 2012) and Daniel Siegel (1999, 2012)
address the developing capacity of the self to organize or self-regulate one’s own
emotional experience. This evolving capacity to self-regulate or self-organize can only
come about with the help of an affectively attuned caregiver. And the nature of the
infant– caregiver relationship determines the shape and quality of the infant’s developing
affective life.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
The preverbal interactions between caregiver and infant are quintessentially socioaf-
fective or psychobiological interactions. The infant who develops a secure attachment
style has done so as a result of the affective attunements of a responsive caregiver; these
interactions are preverbal, presymbolic, and sensation and bodily based. For example,
eye-to-eye gazing between infant and caregiver, largely based in the right hemisphere of
both members of the dyad (McGilchrist, 2009; Schore, 2012), is a sensory emotional
coregulating experience. “In mirroring transactions, a dyadic reciprocal stimulating sys-
tem generates an elevation of regulated sympathetic arousal that supports heightened
levels of interest-excitement and enjoyment-joy” (Schore, 1994, p. 91).
If the infant– caregiver relationship is defined as the crucial “emotion-communicating
system” (Schore, 2012), or emotion-regulating system for the development of the self,
then it functions as the foundation for psychological health and for psychological dys-
function, and for everything in between. Schore’s affect regulation theory spells out how
the formation of an increasingly complex emotion-communicating system, which is
dependent on the caregiver’s capacity to be affectively attuned to the infant, “allows for
an expanding ability to flexibly switch internal bodily based affective states in response to
perceived changes in the external social environment via autoregulation or interactive
regulation(.)” (p. 238). One could say that the personality or the self is the summation of
one’s complex system of self or affect regulation, both autonomously and in interaction
with others, and that adaptive or healthy personality functioning is equivalent to higher
levels of flexibility in affect regulation in response to more complex and varied environ-
mental, specifically socioaffective, environmental demands.
It should be clear that Schore’s affect regulation theory is being used here as the main part
of the framework for conceptualizing the M Axis capacities in dynamic relation to both
implicit processes and to the infant–mother relationship. The remaining sections of this
paper will explore whether or not the nine capacities can be viewed to be the result of
affect regulation, or in the case of a lack of capacity or dysfunction, affect dysregulation.
The other two components of the framework for this paper, dual nature of the self and
infant– caregiver relationship are inherently intertwined conceptually and phenomenally
with affect regulation theory.
124 ETZI
for structures and functions underlying regulation, attention, and learning. More specifi-
cally, it includes auditory processing, language, visual–spatial processing, motor planning
and sequencing, and sensory modulation. However, clinicians are left to their own devices
as to how to assess these processes and to come to any conclusions regarding their
influence on the more comprehensive capacity for regulation, attention, and learning.
Users of the PDM are encouraged to consider executive functioning, memory, attention,
overall intelligence, and the processing of affective and social cues. There is a vast
literature addressing both theory of how these capacities are intertwined with personality
development and functioning, and how to assess and measure these capacities. Porcerelli,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Cogan, and Bambery (2011) present an assessment of an adolescent boy using psychody-
namic measures that help them complete the M Axis for children and adolescents. What
the PDM does not provide in this context is a way to adequately integrate the capacity for
regulation, attention, and learning, and all the subcomponents that this capacity includes,
with a psychodynamic conceptualization of personality functioning. The PDM user is free
to study the psychodynamic theory behind this capacity, but in order to make the PDM
more user friendly and provide it with a broader base of users, critics, researchers, and
educators, the work of explicating Capacity 1 and of integrating it in a systematic way
with complex personality functioning including unconscious/implicit processes, will need
to be done. In other words, once the clinician has assessed what they think of as regulation,
attention, and learning, how is it used for clinical purposes within the psychodynamic
framework, or for that matter any theoretical framework being used by psychotherapists?
Consistent theoretical advances being made in several related disciplines are demon-
strating that the development of psychopathology is the result of both genetic predispo-
sition, temperament, or neurobiological substrate on one hand, and the shaping of that
genetic potential as a result of the early socioemotional attachment to the primary
caregiver on the other hand. In relation to Capacity 1, constitutional contributions can be
understood in conjunction with maturational influences that are the result of the dyadic
socioemotional interactions between infant and caregiver, in other words, attachment
style.
While the PDM does not elaborate in this regard, without the capacity for self-
regulation or affect regulation, individuals will present with disrupted or dysfunctional
ability “to attend to or learn from their experiences” (p. 73). Schore (2012) and Porges
(2012) provide a comprehensive conceptualization based on conclusive empirical support
of the development of adaptive regulation of arousal and psychobiological states, both of
which arise out of autonomic nervous system functioning. Adult affective, cognitive, and
behavior functioning emerge directly out of the development of adaptive regulation of
psychobiological states, and, important to psychodynamic theory, this adaptive regulation
can only occur within the context of the mother–infant dyad wherein the first nonverbal
affective communication takes place. Psychodynamically speaking, the mother functions
as the infant’s auxiliary ego. Also important to psychodynamic theory is the science
clearly demonstrating the “essential psychological processes and biological mechanisms
that underlie the psychobiological substrate of the human unconscious described by
Freud” (Schore, 2012, p. 119).
Greenspan (1989) has discussed ego development in terms of sensory processing and
the organization of sensory/perceptual experience. Stern (1985) and Siegel (1999) have
addressed perception and the mind’s processing of information in terms of representing
reality or organizing incoming stimuli in direct relationship to the caregiver’s simultane-
ous processing and organizing of experience. All of this takes place within the emotional
context of the attachment bond. The early patterns or ways of organizing experience,
Copyrighted Material. For use only by 20021. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org).
according to Greenspan (1989), “may form the basis for later disorders, including
avoidance of the human world, and defects in such basic personality functions as
perception, integration, regulation, and motility” (pp. 9 –10). The work of Fonagy et al.
(2012) demonstrates the role of attachment in the development of the mentalization
capacity for optimal psychological functioning. Ego development, as Greenspan has used
the term, may be viewed as a synonym for the emerging self as the organizer of
experience. Psychoanalysis has long viewed functions such as perception, regulation, and
motility as personality functions, part of the conflict-free ego sphere (Hartmann &
Rapaport, 1958). Therefore, to conceptualize the self as resulting from coregulation of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
126 ETZI
including all the sensory and affective features of that experience. The individual’s
internal representations take shape or emerge out of the dynamic interplay between his
biology (sensory processing) and the earliest socioemotional experiences with the primary
caregiver. Schore (1994, 2012) conceptualizes internal representations in the same vein:
For the rest of the life span, internal working models of the attachment relationship with the
primary caregiver, stored in the right brain, encode strategies of affect regulation that
nonconsciously guide the individual through interpersonal contexts (p. 77). (I)nternal repre-
sentations encode the infant’s physiological–affective responses to the emotionally expressive
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
face of the attachment figure. They can be accessed for regulatory purposes even in the
This document is copyrighted by the American Psychological Association or one of its allied publishers.
a secure attachment is established and an enduring sense of being worthwhile, loved, and
loveable is experienced, even in the face of stress and adversity. Secure attachment sets
the stage for emotional resilience and range of affect tolerance, because the infant has been
attuned to consistently while experiencing a wide range of affects, and therefore antici-
pates that these states can be navigated and tolerated, whether they are pleasant or
unpleasant, whereas insecure attachment raises the risk for psychopathology and dysfunc-
tion in this capacity.
Capacity III may be the most straightforward and self-explanatory of the nine capac-
ities on the surface. However, when unconscious functioning is taken into account, the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
128 ETZI
the multisensory construction of experience including all sensory and affective features of
the experience. Schore (1994) refers to an enduring interactive representation, which
emerges from the way the caregiver regulates or dysregulates the affective experiences of
the infant. It is the experience of being with the caregiver that is internalized or
consolidated into a working model of the relationship.
Internal representations develop during infancy and emerge from the repeated inter-
actions with the caregiver. These interactions are constituted by visual–facial, auditory–
prosodic, and tactile/gestural communications. They are simultaneously bodily and social
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
engender a sense of security in the infant, then the resulting internal representations will
be encoded as stressful, setting up a long-term pattern of psychobiological functioning
dominated by stress responses. Internal representations are the multisensory laying down,
hard-wiring in the brain, of those repeated interactions with the caregiver; they are the
basic building blocks of personality functioning.
Secure attachment bonds lead to representational elaboration and increasing differen-
tiation and complexity, which in turn results in more complex symbolization of internal
life, as compared with insecure attachment bonds, which tend to rigidify around defensive
modes of relating and functioning. The early attachment interactions are internalized and
function throughout the life span as a regulator of affect and interpersonal behavior
(Schore, 2012).
In order to utilize this capacity when assessing individuals’ personality functioning, it
would be important to answer the question, what does it mean to be unable to form internal
representations? And what does it mean that an individual is unable to use them to
experience a sense of self and others? The PDM describes dysfunction in this capacity in
the following statement:
Unable to use internal representations to experience a sense of self and others or to elaborate
wishes and feelings (e.g., acts out or demands excessive physical closeness when needy)
(p. 80).
It may be that dysfunction in this domain is the result of relational trauma occurring in infancy
and that the internal representation of the caregiver is itself disorganized sufficiently to
incapacitate the infant and later the adult regarding affect regulation and with it a coherent
sense of self and others. If so, then rather than being unable to use internal representations, the
representations are themselves encoded dysfunctional interactions, which are being used
leading to a sense of self that is incoherent or severely depleted. Schore (2012) talks about “the
implosion of the implicit self” (p. 92).
130 ETZI
self and other, and between the internal world and external reality” (p. 65). With a capacity
for differentiation comes an increasing ability to tolerate a wider range and depth of
experiences and external socioaffective demands. When the PDM refers to the fragmen-
tation of internal experience, for example, a psychotherapy patient is unable to differen-
tiate between feelings originating within himself and those feelings he perceives in the
therapist, the capacity for differentiation is involved.
Closely connected to differentiation is the other part of Capacity VII—integration. As
the counterpart to differentiation, integration has to do with bringing the separate elements
together in a more or less coherent and organized way. Wallin (2007) describes integration
as “synthesis and connection. . .[which]fosters balance and an awareness of the nuances
and complexity of experiences.” (p. 65). The inherent complexity of personality func-
tioning and psychological and emotional experience require integration if experience is to
be meaningful and organized, if the person is to be able to adapt flexibly to novel
situations. Schore (2003) linked integration with self-organization: “the process whereby
order and complexity create more order and complexity” (p. 93). Siegel (1999) addresses
integration as the “capacity to interconnect a range of processes within [the mind’s]
present activity, [and] across time.”(p. 301). Contained within integration are “the col-
laborative, linking functions that coordinate various levels of processes within the mind
and between people.”(p. 301). With the inclusion of Capacity VII, the M Axis becomes
capable of assessing the most complex aspects of personality functioning, both those that
occur within the individual and those that occur between and among individuals.
Perhaps the most important result of the capacity for differentiation and integration is
explained by Schore (1994) to be a continuity of inner experience. When separate
self-states or inner states can be integrated within the self, across time, and between self
and others, then the individual’s sense of self is characterized by a high degree of
coherence and continuity. For example, an adolescent struggles with the demands placed
on him by the culture to be a hardworking and conscientious student, to negotiate
increasingly intimate and mutually gratifying relationships, and to get along with peers
and authority figures, to name just a few of the sometimes conflicting roles and demands
he may experience. Some experiences may trigger intense anxiety, others excitement, but
they require the ability to have them cohere and exist alongside each other; the adolescent
is required to move in and out of them with flexibility.
capacity itself so that the clinician can assess how the client’s ability to observe feelings
will be impacted by how one handles stress, the type of defenses used and their relative
rigidity or flexibility.
It is possible to link the self-observing capacity to other capacities and elements of
other M Axis capacities, but notably specifically to affect regulation, affect comprehen-
sion and emotion experiences. In Schore’s words: “Self-organizing appraisals thus involve
feedback between social cognition and emotion” (2003, p. 36). My reading of “self-
organizing appraisals” in the present context has to do with the ability to organize one’s
own emotional experiences, especially when under any amount of emotional distress, as
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
a result of the ability to stop and think or reflect on that experience in spite of its intensity
or discomfort. Like all the other capacities, this one also depends on the early infant–
caregiver interactions. Because those earliest interactions take place within a certain
emotional atmosphere, the ability to experience oneself in an organized way will become
internalized and endure as part of the developing individual’s personality functioning. The
capacity to evaluate change in the environment, especially the socioemotional environ-
ment, and in the self, is crucial to adaptive personality development, and the self-
observing capacity is an essential part of evaluating that change relevant to one’s own
experience. Peter Fonagy’s (2012) work on mentalization may be especially relevant to
this capacity, but it is beyond the scope of this paper to address it properly.
Summary
After delineating the elements of the PDM’s M Axis, I hoped to have shown that it
contains a wealth of tools in the form of concepts and ideas that describe the very complex
and dynamic reality of personality functioning, both adaptive and maladaptive. Psycho-
therapists of all theoretical orientations have long recognized the inadequacy of the DSM
Copyrighted Material. For use only by 20021. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org).
132 ETZI
for providing anything beyond a label of mental dysfunction derived from a short list of
surface-based symptoms, which have not held up well under the scrutiny of research. The
medical model approach does not come close to meeting the needs of psychotherapists,
especially those who work with a depth-psychology orientation, for example, psychoan-
alytic and psychodynamic psychotherapists, because the medical model’s focus on symp-
toms implies a treatment that will reduce or eliminate symptoms. On the contrary,
psychodynamic psychotherapists are keenly attuned to the psychotherapy process, most of
which is unspoken and unconscious and psychodynamic developmental theory acknowl-
edges the profound influence that unconscious processing has on personality development
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Fonagy, P., Luyten, P., & Strathearn, L. (2011). Borderline personality disorder, mentalization, and
the neurobiology of attachment. Infant Mental Health Journal, 32, 47–69. doi:10.1002/
imhj.20283
Ginot, E. (2007). Intersubjectivity and neuroscience: Understanding enactments and their
therapeutic significance within emerging paradigms. Psychoanalytic Psychology, 24, 317–332.
doi:10.1037/0736-9735.24.2.317
Greenspan, S. I. (1989). The development of the ego: Implications for personality theory, psycho-
pathology, and the psychotherapeutic process. Madison, CT: International Universities Press.
Hartmann, H., & Rapaport, D. (Trans) (1958). Ego psychology and the problem of adaption.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Huprich, S. K. (2011). Reclaiming the value of assessing unconscious and subjective psychological
experience. Journal of Personality Assessment, 93, 151–160. doi:10.1080/
00223891.2010.542531
Kernberg, O. F. (1984). Severe personality disorders. New Haven, CT: Yale University Press.
Kernberg, O. F., & Caligor, E. (2005). A psychoanalytic theory of personality disorders. In J. F.
Clarkin & M. F. Lenzenweger (Eds.), Major theories of personality disorder (2nd ed., pp.
114 –156). New York: Guilford.
McGilchrist, I. (2009). The master and his emissary: The divided brain and the making of the
western world. New Haven, CT: Yale University Press.
McWilliams, N. (1994). Psychoanalytic diagnosis: Understanding personality structure in the
clinical process. New York, NY: Guilford.
Newton, R., & Schore, A. N. (2012). Using regulation theory to guide clinical assessments of
mother-infant attachment relationships. In A. N. Schore (Ed.), The science of the art of
psychotherapy (pp. 383–427). New York, NY: W. W. Norton & Co.
PDM Task Force (Ed.) (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of
Psychoanalytic Organizations.
Porcerelli, J. H., Cogan, R., & Bambery, M. (2011). The mental functioning axis of the Psychody-
namic Diagnostic Manual: An adolescent case study. Journal of Personality Assessment, 93,
177–184. doi:10.1080/00223891.2011.542724
Porges, S. W. (2011). The polyvagal theory. New York, NY: W. W. Norton & Co.
Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional
development. Hillsdale, NJ: Erlbaum.
Schore, A. N. (2003). Affect dysregulation and disorders of the self. New York, NY: W. W. Norton
& Co.
Schore, A. N. (2012). The science of the art of psychotherapy. New York, NY: W. W. Norton & Co.
Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. New
York, NY: Guilford.
Siegel, D. J. (2010). The mindful therapist. New York, NY: W. W. Norton & Co.
Siegel, D. J. (2012). Pocket guide to interpersonal neurobiology: An integrative handbook of the
mind. New York: W.W. Norton & Co.
Stern, B. L., Caligor, E., Clarkin, J. F., Critchfield, K. L., Horz, S., MacCornack, V., . . . Kernberg,
O. F. (2010). Structured Interview of Personality Organization (STIPO): Preliminary psycho-
metrics in a clinical sample. Journal of Personality Assessment, 92, 35–44. doi:10.1080/
00223890903379308
Stern, D. (1985). The interpersonal world of the human infant. New York, NY: Basic.
Wallin, D. (2007). Attachment in psychotherapy. New York, NY: Guilford.
PEP-Web Copyright
Copyright. The PEP-Web Archive is protected by United States copyright laws and international treaty provisions.
1. All copyright (electronic and other) of the text, images, and photographs of the publications appearing on PEP-Web is retained by
the original publishers of the Journals, Books, and Videos. Saving the exceptions noted below, no portion of any of the text, images,
photographs, or videos may be reproduced or stored in any form without prior permission of the Copyright owners.
2. Authorized Uses. Authorized Users may make all use of the Licensed Materials as is consistent with the Fair Use Provisions of
United States and international law. Nothing in this Agreement is intended to limit in any way whatsoever any Authorized User’s
rights under the Fair Use provisions of United States or international law to use the Licensed Materials.
3. During the term of any subscription the Licensed Materials may be used for purposes of research, education or other
non-commercial use as follows:
a. Digitally Copy. Authorized Users may download and digitally copy a reasonable portion of the Licensed Materials for their own use
only.
b. Print Copy. Authorized Users may print (one copy per user) reasonable potions of the Licensed Materials for their own use only.
Copyright Warranty. Licensor warrants that it has the right to license the rights granted under this Agreement to use Licensed
Materials, that it has obtained any and all necessary permissions from third parties to license the Licensed Materials, and that use of
the Licensed Materials by Authorized Users in accordance with the terms of this Agreement shall not infringe the copyright of any third
party. The Licensor shall indemnify and hold Licensee and Authorized Users harmless for any losses, claims, damages, awards,
penalties, or injuries incurred, including reasonable attorney's fees, which arise from any claim by any third party of an alleged
infringement of copyright or any other property right arising out of the use of the Licensed Materials by the Licensee or any Authorized
User in accordance with the terms of this Agreement. This indemnity shall survive the termination of this agreement. NO LIMITATION
OF LIABILITY SET FORTH ELSEWHERE IN THIS AGREEMENT IS APPLICABLE TO THIS INDEMNIFICATION.
Commercial reproduction. No purchaser or user shall use any portion of the contents of PEP-Web in any form of commercial
exploitation, including, but not limited to, commercial print or broadcast media, and no purchaser or user shall reproduce it as its own
any material contained herein.