Abstract
The quality of object relations affects interpersonal behaviour, but it is not known whether it modifies effectiveness on personality functioning in psychotherapies of different mode and length. In this study we estimated the modifying effect of the quality of object relations on the effect of solution-focused therapy (SFT) and shortand long-term psychodynamic psychotherapy (SPP and LPP) on self-concept. A total of 326 patients were assessed at baseline with the Quality of Object Relations Scale (QORS) and 4 times during a 3-year follow-up with the Structural Analysis of Social Behavior self-concept questionnaire, comprising altogether 10 scores on different aspects of self-concept pathology. The effectiveness of SFT, but not SPP, was significantly poorer in several domains (5/10) of self-concept for patients with low QORS, i.e. those with less mature relational patterns, than for patients with high QORS, while the reversal occurred in some (3/10) self-concept domains in LPP. The results suggest that the quality of object relations has significance for treatment selection in therapies with different mode and length.
Highlights
Long-term changes in maladaptive and relatively enduring personality characteristics propose specific challenges beyond reduction of psychiatric symptoms for different psychotherapies and are often primary targets of therapy when personality pathology is involved [1]
In long-term psychodynamic psychotherapy (LPP) a reversed phenomenon was noted in three self-concept scores (AF, self-attack, self-love), indicating better outcomes, e.g. the AF score difference being 23.8 (CI = 1.32, 46.3) at the 12 month follow-up, for patients with low than high Quality of Object Relations Scale (QORS), whereas thereafter no effect modification was found in any of the self-concept scores
The statistically significantly different change profiles in low vs. high QORS in solution-focused therapy (SFT) are illustrated by the self-free domain, where the modification was most extensive, in comparison to the respective differences in LPP (Figure 1)
Summary
Long-term changes in maladaptive and relatively enduring personality characteristics propose specific challenges beyond reduction of psychiatric symptoms for different psychotherapies and are often primary targets of therapy when personality pathology is involved [1]. The development of more benign internal self-representations, i.e. internalized mental models or schemas which guide behavior, affects and cognitions, according to the interpersonal and introject theory [2,3,4], is considered to represent sustained benefits of psychotherapies for individuals with affective and personality disorders [5]. Based on the Helsinki Psychotherapy Study [7], a randomized study on the effectiveness of two different modalities of short-term therapies, brief solution-focused (SFT) and transference-focused psychodynamic (SPP), and long-term psychodynamic psychotherapy (LPP) was conducted, we recently found that during the course and shortly after the end of the short-term therapies SFT and SPP, there was a more beneficial effect on self-concept than LPP [8]. Some support for greater self-concept changes, linked with somewhat longer therapy duration, has been found in a study of brief to moderate length cognitive therapy [9], whereas in a study of two modalities of short-term psychodynamic psychotherapies with equal length, differences on a specific self-concept aspect, self-protect, appeared between therapies with different technique (transference focused vs. non-transference focused), modified by patient’s motivation [10]
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