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

In Transference-Focused Psychotherapy (TFP), the evidence-based treatment for personality pathology informed by Kernberg’s object relations theory, pathological object relations (OR) dyads – self and other representations linked by affect – are systematically identified, called out, and integrated within the therapeutic relationship. Although dyadic activation is central to TFP technique, clinicians currently lack a standardized method to assess how dyads emerge and shift in therapeutic interactions. The Dyads Clinician Rating Tool (DyCTO) is a novel observer-rated tool which operationalizes OR dyads as they are enacted in patient–clinician exchanges. The DyCTO provides a structured grid for identifying moments of peak affective activation and the subsequent emergence of self and other representations, allowing for the fine-grained analysis of relational dynamics during therapeutic sessions. Beyond research applications, the tool was developed to support TFP clinicians by offering a shared observational language for case formulation, training, and supervision. This study reports preliminary validation data for the DyCTO. The tool was applied to audio recordings of Structured Interviews for Personality Organization from 24 participants (15 dual diagnosis patients, 9 nonclinical controls). Inter-rater reliability was assessed on a subset of interviews (25%) coded by three independent raters. Preliminary validity was examined through group comparisons and associations between DyCTO indices and the Level of Personality Functioning Scale (LPFS). Results indicate satisfactory inter-rater reliability for both quantitative and categorical DyCTO scores. Several DyCTO indices differentiated clinical from nonclinical participants and showed partial convergence with LPFS dimensions. Although further validation with larger clinical samples is warranted, these findings support the DyCTO as a promising method for systematically capturing dyadic activation in clinical interactions. The DyCTO may enhance psychotherapy process research while also serving as a practical assessment and training tool for supervision and technique adherence within TFP.