Suicide has been recognized for several decades as a major public health issue; up to 80% of patients admitted to the Austen Riggs Center report a recent history of suicidal ideation, and a substantial portion of these report a further history of past suicide attempts and other self-harming behaviors. Given that suicidal ideation is known to fluctuate drastically over time, methods that move beyond single assessment point approaches and a reliance on retrospective self-report are urgently needed.

Over the past decade, Drs. Jane Tillman and Katie Lewis have incorporated innovative mixed methods approaches to study factors affecting momentary changes in suicide risk and proximal states of mind preceding near-lethal suicidal action. In addition to identifying implicit personality processes associated with more chronic suicidal behavior (Lewis et al., 2016, 2019), these studies have illuminated common themes and conflicts that emerge in the thoughts of suicidal individuals shortly before an attempt (Tillman, Stevens, & Lewis, 2021), and trajectories of change in resilience and psychic pain over the course of several years in individuals known to be at elevated risk for suicide (Tillman et al., 2019). Other recently completed studies have focused on the development and psychometric evaluation of a new theoretically grounded measure of psychic pain (the Psychic Pain Scale; Lewis et al., 2021), and factors affecting risk for suicidal ideation during the COVID-19 pandemic (Lewis et al., 2022a and b; Lewis et al., 2023).

Currently, two active studies are underway which employ smartphone-based experience sampling methods to evaluate proximal changes in suicide risk over time. Rooted in the broader Riggs belief that relationships are instrumental in supporting long-term adaptive functioning and resilience, these studies examine how daily interpersonal exchanges, social perceptions and beliefs, and emotional functioning influence short-term changes in suicidal thoughts and impulses. Other relevant physiological factors such as sleep disturbance are incorporated to address a fuller range of potential biopsychosocial risk factors. Together, these studies seek to advance understanding of the impact of relationships, emotional functioning, and health on short-term changes in suicide risk, with the goal of informing treatment and advancing clinical knowledge.

Lewis, K., Roche, M. J., Brown, F., Tillman, J. (2023). Intolerance of aloneness as a prospective predictor of suicidal ideation during COVID-19. Journal of Affective Disorders-Reports. DOI: 10.1016/j.jadr.2023.100469

Lewis, K., Roche, M. J., Brown, F., Tillman, J. (2022). Attachment, loneliness, and social connection as prospective predictors of suicidal ideation during the COVID-19 pandemic: a relational diathesis-stress experience sampling study. Suicide & Life-Threatening Behavior. DOI: 10.1111/sltb.12922

Tillman, J. G., Stevens, J. L., & Lewis, K. (2021). States of mind preceding a near-lethal suicide attempt: A mixed methods study. Psychoanalytic Psychology. Advance online publication. DOI: 10.1037/pap0000378

Lewis, K., Good, E., Tillman, J., Hopwood, C. (2021). Assessment of psychological pain in clinical and non-clinical samples: A preliminary investigation using the Psychic Pain Scale. Archives of Suicide Research, 25(3), 552-569. DOI: 10.1080/13811118.2020.1729914

Lewis, K., Meehan, K., Cain, N., Wong, P., Clemence, A.J., Stevens, J., & Tillman, J. (2021). Quality of internalized object representations and suicidality in individuals with anaclitic and introjective personality styles. Journal of Personality Disorders, 35(1), 145-160. DOI: 10.1521/pedi_2019_33_435

Tillman, J., Clemence, A. J., Hopwood, C., Lewis, K., Stevens, J. (2017). Suicidality in high-risk psychiatric patients: The role of protective factors in predictive validity. Psychiatry: Interpersonal and Biological Processes, 80(4), 357-373. DOI: 10.1080/00332747.2017.1296309

Tillman, J. G., Clemence, A. J., Cree, R., Lewis, K. C., Stevens, J. L., & Reiss, D. (2017). The persistent shadow of suicide ideation and attempts in a high-risk group of psychiatric patients: A focus for intervention. Comprehensive Psychiatry, 77, 20–26. DOI: 10.1016/j.comppsych.2017.05.005

Jane G. Tillman, PhD, ABPP
Katie C. Lewis, PhD
Jennifer Stevens, PhD, ABPP
Fiona Brown, LCSW

Beginning in the 1940s with the work of renowned Riggs staff members David Rapaport, Roy Schafer, and Merton Gill, the Austen Riggs Center has made significant contributions to the field of personality assessment and interpersonal processes. Several studies at Austen Riggs have incorporated psychological testing data into studies aimed at evaluating both the timing and manner in which patients grow and improve over the course of treatment. The Riggs-Yale Study (initiated in 1978), for example, led by Riggs staff member Richard Q. Ford, PhD, and Sidney J. Blatt, PhD, of Yale University, investigated changes over the course of treatment through patient responses to the Rorschach Inkblot Method and the Thematic Apperception Test, culminating in the seminal book Therapeutic Change: An Object Relations Perspective (1994).

While interpersonal relationships are a common point of focus across the various empirical studies being conducted at Austen Riggs, several projects associated with the Psychological Testing Program (overseen by Director of Psychological Testing, Jeremy M. Ridenour, PsyD, ABPP) have focused in greater detail on identifying the psychometric properties of common personality assessment methods, as well as illustrations of how multimethod assessment approaches can be integrated to gain a clearer picture of clinical functioning and change over time. Projects involving the ongoing prospective collection of assessment data have enabled Riggs researchers to evaluate the ways in which personality assessment findings can inform long-term treatment and improvement, serving to clarify potential points of intervention for individuals depending on their individual personality characteristics and traits.

Ridenour, J., Lewis, K. C., Siefert, C., Stein, M. (2022). Longitudinal stability of SCORS-G dimensional ratings, score ranges, and narrative “blandness” in a clinical sample. Clinical Psychology & Psychotherapy. DOI: 10.1002/cpp.2729

Ridenour, J., Lewis, K., Siefert, C., Pitman, S., Knauss, D., Stein, M. (2021). Card pull effects of the TAT using the SCORS-G on a complex psychiatric sample. Clinical Psychology & Psychotherapy, 28(5), 1079-1090. DOI:10.1002/cpp.2554 

Lewis, K., Ridenour, J., Pitman, S., Roche, M. (2021). Evaluating stable and situational expressions of passive-aggressive personality disorder: a multimethod EMA case study. Journal of Personality Assessment, 103(4), 558-570. DOI:10.1080/00223891.2020.1818572

Lewis, K., Ridenour, J. (2020). The integration of EMA and single-occasion multimethod assessment data for a complex psychiatric patient. Assessment, 27(7), 1532-1546. DOI: 10.1177/1073191118825313.

Blatt, S. J., Ford, R. Q., Berman, W. H., Jr., Cook, B., Cramer, P., & Robins, C. E. (1994). Therapeutic change: An object relations perspective. Plenum Press. DOI: 10.1007/978-1-4899-1010-3.

Between the years of 1992 and 2001, researchers at the Austen Riggs Center conducted a longitudinal study of naturalistic change in a sample of 226 Austen Riggs patients entitled the “Follow-Along Study” (FAS). Initially co-led by Drs. J. Christopher Perry and Eric Plakun, the study evaluated psychological functioning across multiple domains, starting at the point of admission to treatment up to nearly a decade later. Patients completed self-report questionnaires and interviews which explored their perceptions of changes in emotional health, adaptive functioning, reflective and relational capacities, and sense of self over time, encompassing both the period of their time in treatment at Riggs as well as overall adjustment in the years following discharge. Now overseen as an archival dataset by Principal Investigator Marilyn Charles, PhD, the FAS continues to serve as an invaluable resource for ongoing empirical explorations of changes in personality functioning and emotional health in adult psychiatric patients over time.

J. Christopher Perry & J. Christopher Fowler (2021) A Naturalistic Study of Time to Recovery in Adults with Treatment-refractory Disorders, Psychiatry, 84:3, 260-275, DOI: 10.1080/00332747.2021.1907869.

Gomez and Charles (2020) Mythological Bridge Between Intergenerational Transmission of Unmourned Loss and Addiction. The Psychoanalytic Review, Apr;107(2):153-174. DOI: 10.1521/prev.2020.107.2.153.

Clemence, A. J., Fowler, J. C., Gottdiener, W., Krikorian, S., Charles, M., Damsky, L., & Johnson, B. (2012). Microprocess examination of therapeutic immediacy during a dynamic research interview. Psychotherapy: Theory, Research, Practice, Training, 49(3), 317–329. DOI: 10.1037/a0026090.

Clemence, A. J. & Lewis, K. C. (2018) Flexibility and Rigidity in Object Relational Functioning: Assessing Change in Suicidal Ideation and Global Psychiatric Functioning Using the SCORS–G, Journal of Personality Assessment, 100:2, 135-144. DOI: 10.1080/00223891.2017.1418747.

Clemence, A. J., Perry, J. C., & Plakun, E. M. (2009). Narcissistic and borderline personality disorders in a sample of treatment refractory patients. Psychiatric Annals, 39(4). DOI: 10.3928/00485713-20090401-05.

Perry, C. J., Fowler, J. C., Bailey, A., Clemence, A. J., Plakun, E. M., Zheutlin, B., & Speanburg, S. (2009). Improvement and recovery from suicidal and self-destructive phenomena in treatment-refractory disorders. The Journal of Nervous and Mental Disease, 197(1), 28-34. DOI: 10.1097/NMD.0b013e3181927598.

Ackerman, S. J., Clemence, A. J., Weatherill, R., & Hilsenroth, M. J. (1999). Use of the TAT in the assessment of DSM-IV Cluster B personality disorders. Journal of Personality Assessment, 73(3), 422-448. DOI: 10.1207/S15327752JPA7303_9.

Marilyn Charles, PhD, ABPP
Steven J. Ackerman, PhD
Eric Plakun, MD
David Neal, PsyD

Potential pathways of change over the course of treatment in adult psychiatric patients are currently the focus of study in both the residential treatment program (under the leadership of Dr. Steven Ackerman) and Remote Access Intensive Outpatient Program (under the leadership of Dr. Seth Pitman). These initiatives seek to evaluate the nature of change experienced by patients during intensive psychoanalytic treatment across both transdiagnostic indicators of impairment -including interpersonal functioning, mood symptoms, and reduced resilience and sense of wellbeing - as well as patterns of change in individuals with different psychiatric diagnoses. Specific aspects of treatment and the therapeutic relationship, such as quality of the patient-therapist alliance, are additional areas of focus being examined in relation to treatment outcome. Findings will clarify both the timing and course of recovery from persistent psychological distress and illuminate the therapeutic factors that contribute to positive engagement and sustained adaptation. 

TBD

Steven J. Ackerman, PhD
Katie C. Lewis, PhD
Seth Pitman, PhD
Fiona Brown, LCSW

Morey, C (2022) Co‑constructing a Conceptual Understanding of System Enactment. Clinical Social Work Journal, January 13. DOI: 10.1007/s10615-021-00829-5.

Lewis, K., Roche, M. J., Brown, F., Tillman, J. (2022). Reduced social contact and attachment insecurity as predictors of loneliness during COVID-19: a two- month experience sampling study. Personality and Individual Differences, 195, 111672. DOI: 10.1016/j.paid.2022.111672.

Ridenour, J., Lewis, K. C., Siefert, C., Stein, M. (2022). Longitudinal stability of SCORS-G dimensional ratings, score ranges, and narrative “blandness” in a clinical sample. Clinical Psychology & Psychotherapy. DOI: 10.1002/cpp.2729.

Tillman, J. G., Stevens, J. L., & Lewis, K. (2021). States of mind preceding a near-lethal suicide attempt: A mixed methods study. Psychoanalytic Psychology. Advance online publication. DOI: 10.1037/pap0000378.

Ridenour, J., Lewis, K., Siefert, C., Pitman, S., Knauss, D., Stein, M. (2021). Card pull effects of the TAT using the SCORS-G on a complex psychiatric sample. Clinical Psychology & Psychotherapy, 28(5), 1079-1090. DOI:10.1002/cpp.2554. 

Lewis, K., Ridenour, J., Pitman., S., Roche, M. (2021). Evaluating stable and situational expressions of passive-aggressive personality disorder: a multimethod EMA case study. Journal of Personality Assessment, 103(4), 558-570. DOI:10.1080/00223891.2020.1818572.

Lewis, K., Good, E., Tillman, J., Hopwood, C. (2021). Assessment of psychological pain in clinical and non-clinical samples: A preliminary investigation using the Psychic Pain Scale. Archives of Suicide Research, 25(3), 552-569. DOI: 10.1080/13811118.2020.1729914.

Lewis, K., Meehan, K., Cain, N., Wong, P., Clemence, A.J., Stevens, J., & Tillman, J. (2021). Quality of internalized object representations and suicidality in individuals with anaclitic and introjective personality styles. Journal of Personality Disorders, 35(1), 145-160. DOI: 10.1521/pedi_2019_33_435.

Gomez and Charles (2020) Mythological Bridge Between Intergenerational Transmission of Unmourned Loss and Addiction. The Psychoanalytic Review, Apr;107(2):153-174. DOI: 10.1521/prev.2020.107.2.153.

Lewis, K. (2020). COVID-19: Preliminary data on the impact of social distancing on loneliness and mental health. Journal of Psychiatric Practice, 26(5), 400-404. DOI: 10.1097/PRA.0000000000000488.

Lewis, K., Ridenour, J. (2020). The integration of EMA and single-occasion multimethod assessment data for a complex psychiatric patient. Assessment, 27(7), 1532-1546. DOI: 10.1177/1073191118825313.

Churchill, H; Ridenour, J (2019) Coming together through falling apart: using psychological assessment within a developmental framework to assess change. Rorschachiana 40(2)151-168. DOI: 10.1027/1192-5604/a000115.

Ridenour, J. M., & Zimmerman, B. (2019). The Evolution of Psychological Testing at the Austen Riggs Center: A Theoretical Analysis. Journal of Personality Assessment, 101(1), 106–115. DOI: 10.1080/00223891.2017.1336717.

Ridenour, J., Lewis, K., Poston, J., Ciecalone, D. (2019). Performance-based assessment of social cognition in borderline versus psychotic psychopathology. Rorschachiana, 40, 95-111. DOI: 10.1027/1192-5604/a000114.

Clemence, A. J., Lewis, K. (2018). Flexibility and rigidity in object relational functioning: assessing change in suicidal ideation and global psychiatric functioning using the SCORS-G. Journal of Personality Assessment, 100(2), 135-144. DOI 10.1080/00223891.2017.1418747.

Tillman, J.G. (2018). Special Section: Developmental and psychosocial aspects of suicidality: Treating patients and understanding survivors. (Guest Editor of special section). Psychoanalytic Study of the Child. Vol. 71, pp. 1-96. DOI: 10.1080/00797308.2018.1427940.

The Suicide and Self-Destructive Behaviors Study Group (Damsky, L., Elmendorf, D., Tillman, J.G., Weinberg, E.F.) (2018) Integrative psychodynamic model for understanding and assessing the suicidal patient. Psychoanalytic Psychology., pp. 424-432. DOI: 10.1037/pap0000171.

Pitman, S. R., Hilsenroth, M. J., Weinberger, J., Conway, F., & Owen, J. (2017). Psychotherapy technique related to changes in anxiety symptoms with a transdiagnostic sample. Journal of Nervous and Mental Disease, 205(6), 427–435. DOI: 10.1097/NMD.0000000000000689.

Yalof, J. (2017). A Sequential-Narrative Psychodynamic Approach to TAT Interpretation. Institutionalised Children Explorations and Beyond, 4(2), 147–159. DOI: 10.1177/2349301120170206.

Tillman, J., Clemence, A. J., Hopwood, C., Lewis, K., Stevens, J. (2017). Suicidality in high-risk psychiatric patients: The role of protective factors in predictive validity. Psychiatry: Interpersonal and Biological Processes, 80(4), 357-373. DOI: 10.1080/00332747.2017.1296309.

Tillman, J. G., Clemence, A. J., Cree, R., Lewis, K. C., Stevens, J. L., & Reiss, D. (2017). The persistent shadow of suicide ideation and attempts in a high-risk group of psychiatric patients: A focus for intervention. Comprehensive Psychiatry, 77, 20–26. DOI: 10.1016/j.comppsych.2017.05.005.

Charles, M., Durham-Fowler, J., & Malone, J. (2016). Factors that discriminate creative engagement on an unstructured task: Creativity and the Rorschach. Bulletin of the Menninger Clinic, 80(2), 97–130. DOI: 10.1521/bumc.2016.80.2.97.

Lewis, K., Meehan, K., Cain, N., Wong, P., Clemence, A.J., Stevens, J., & Tillman, J. (2016). Impairments in object relations and chronicity of suicidal behavior in individuals with borderline personality disorder. Journal of Personality Disorders, 30(1), 19-34. DOI: 10.1521/pedi_2015_29_178.

Lusignan, T., Turner, B., Rosenthal, D., & Morey, C. (2015). The Dynamic Family Functioning Instrument: A Preliminary Exploration. Journal of the American Psychoanalytic Association, 63(5), NP3–NP7. https://doi.org/10.1177/0003065115609725

Clemence, A. J., Tillman, J. G., & Poston, J. M. (2015). How to include analytic patients in research and how this affects treatment. Psychoanalytic Inquiry, 35, 135–149. https://doi.org/10.1080/07351690.2015.987599

Poster Award, American Psychoanalytic Association 2014 (Katie C. Lewis, Jane G. Tillman)

Stuart Hauser Memorial Poster Award, Psychoanalytic 2014 (Katie C. Lewis, Jane G. Tillman)

Ernest and Gertrude Ticho Award, American Psychoanalytic Association (Jane G. Tillman)

Martin Mayman Award, Society for Personality Assessment, 2022 (Katie C. Lewis, Jeremy M. Ridenour, Seth Pitman)

Professional Poster Award, American Association of Suicidology, 2019 (Jane G. Tillman, Katie C. Lewis)

Marguerite R. Hertz Memorial Presentation, Society for Personality Assessment, 2019 (Jeremy M. Ridenour, Jed Yalof)

APA Division 39 Early Career Professional Scholar Award, 2016 (Jeremy M. Ridenour)

National Institute of Mental Health (NIMH) Exploratory/Developmental Research Grant (Katie C. Lewis, Co-PI), for project entitled “Influence of Daily Disruptions in Sleep and Self-Regulation on Proximal Risk for Suicide,” 2019-2022.

American Foundation for Suicide Prevention’s Young Investigator Grant (Katie C. Lewis, PI; Thomas Joiner, Jr., PhD, Mentor), for project entitled “Impact of interpersonal experiences on suicidal thoughts and behaviors,” 2018-2022.

Robert S. Wallerstein Psychoanalytic Research Fellowship (Katie C. Lewis, PI), for project entitled “Impact of interpersonal experiences on maladaptive thoughts and behaviors: An object relations EMA study.” 2017-2022.

American Psychological Foundation/Division 39 McCary Fund for Psychoanalysis (Katie C. Lewis, PI), for project entitled “Longitudinal Adaptation to Loss During COVID-19: An Attachment Perspective.” 2020-2021.

American Psychoanalytic Association (Jane G. Tillman, PI), for project entitled “Follow Up to States of Mind Preceding a Near Lethal Suicide Attempt Study.” 2018-2019.

American Psychoanalytic Association (Jane G. Tillman, PI), for project entitled “States of mind preceding a near-lethal suicide attempt: A mixed methods study.” 2009-2010.

International Psychoanalytic Association (Jane G. Tillman, PI), for project entitled “States of mind preceding a near-lethal suicide attempt: A mixed methods study.” 2010-2012.

International Psychoanalytic Association (Jane G. Tillman, PI), for project entitled “Effect of Patient Suicide on Therapists.” 2002-2004.

American Psychological Foundation (APF) Katkovsky Award (David Mintz, PI), for project entitled Psychodynamic Psychopharmacology: Phase I - Fidelity Testing”. 2018.