The Dyads Clinician Rating Tool (DyCTO): preliminary validation of an observer-rated grid for object relations dyads

Transference-Focused Psychotherapy (TFP) is an evidence-based treatment for personality disorders grounded in Kernberg’s object relations theory, conceptualizing personality pathology in terms of maladaptive internalized representations of self and others linked by dominant affects. These configurations, called object relations dyads, are activated and observed within the therapeutic relationship and gradually integrated to promote a more stable sense of identity, affective regulation, and interpersonal functioning. Despite the centrality of relational patterns in treatments for personality disorders, few assessment tools exist to systematically capture how self-other representations emerge in clinical interactions. The Dyads Clinician Rating Tool (DyCTO) is a novel observer-rated instrument developed to operationalize object relations dyads as they unfold in patient-clinician exchanges. Using a structured coding grid, the DyCTO identifies self- and other-representations and their affective links, enabling a sophisticated analysis of interpersonal processes relevant to the treatment of personality pathology. This study presents preliminary validation data for the DyCTO, which was applied to audio recordings of Structured Interviews for Personality Organization from 24 participants (15 clinical, 9 nonclinical). Three independent raters coded a subset of interviews (25%) to evaluate inter-rater reliability. Preliminary validity analyses examined group differences and associations between DyCTO indices and the Level of Personality Functioning Scale (LPFS). Results showed satisfactory inter-rater reliability for both quantitative and categorical DyCTO scores. Several DyCTO dimensions differentiated clinical from nonclinical participants and partially converged with LPFS domains. These findings support the DyCTO’s potential as a reliable and clinically meaningful method for assessing internalized relational patterns in personality pathology in the here-and-now of clinical interactions. The DyCTO offers potential applications in psychotherapy research, clinical assessment, training, and supervision across multiple therapeutic orientations.