Mature Object Relations Research Articles

Custody Conflict as a Developmental Trauma

ABSTRACT While parental divorce can have a profound effect on the development of a child, the effect of a custody conflict following divorce can have an extreme, traumatic, and lifelong impact on a child. The conflict between the parents that occurred prior to their divorce can be sustained long after the parental divorce, reinforcing highly dysfunctional patterns of relationships between the parents, between each parent and child, and then put the child at risk for pathological patterns of relationships with peers and intimates. Though difficulties in the development of mature object relations and a mature sense of self are obviously at risk given this milieu of overt interpersonal conflict, anger, hatred, and parental preoccupation, difficulties in a child’s capacity to explore the environment, i.e. play, learn academically, and value their body can also be adversely affected. This paper presents cases from varying stages of childhood development to demonstrate the potentially traumatic effects on the development of children living through parental custody conflict, as well as the lifelong effect on an adult experiencing a parental custody conflict in childhood.

Changes in dreams - the development of a dream-transformation scale in psychoanalyses with chronically depressed, early traumatized patients

ABSTRACT As is well known, dreams are still seen as via regia to the unconscious by many psychodynamic and psychoanalytic clinicians and researchers. Therefore, this article reports on decades of efforts to understand changes in manifest dreams in psychodynamic therapies as indicators for relevant, sustaining transformations in the inner object world of patients and to use them in comparative psychotherapy outcome studies. An empirical psychotherapy study by Leuzinger-Bohleber has described the following changes in manifest dream during successful psychoanalyses: reduction of nightmares, widening of the affective spectrum, increase of successful problemsolving, fewer observer dreams and more mature object relations. These transformations are illustrated in a detailed case report of a chronically depressed, early traumatized patient of the LAC Depression Study. In the next section the results of a systematic focused literature review aiming to identify suitable instruments for the study of dreams are presented. Finally, we discuss which conclusions can be drawn for the development of a dream transformation scale capturing changes in manifest dreams in psychodynamic therapies with depressive patients. Such a scale would be an important methodological addition for future comparative psychotherapy outcome studies, since it takes into account dreams, as a genuinely psychoanalytic criterion for psychic transformations.

The Missing Father Function in Psychoanalytic Theory and Technique: The Analyst’s Internal Couple and Maturing Intimacy

This paper argues that recovering the “missing” paternal function in analytic space is essential for the patient’s achievement of mature object relations. Emerging from the helpless infant’s contact with primary caregivers, mature intimacy rests on establishing healthy triadic functioning based on an infant-with-mother-and-father. Despite a maternocentric bias in contemporary clinical theory, the emergence of triangularity and the inclusion of the paternal third as a separating element is vital in the analytic dyad. Effective technique requires the analyst’s balanced interplay between the paternal, investigative and the maternal, maximally receptive modes of functioning—the good enough analytic couple within the analyst—to serve as the separating element that procreatively fertilizes the capacity for intimacy with a differentiated other. A clinical example illustrates how treatment is limited when the paternal function is minimized within more collusive, unconsciously symbiotic dyads.

What difference does a decade make? Psychoanalysis and homosexuality, 2002–2012

This humorous survey of case studies published in North America between 2002 and 2012 engages the audience in a fly-on-the-wall thought experiment (imaginative ethnography) to highlight seeds of change and to celebrate reconciliation efforts between psychoanalysis and homosexuality. At the same time, it suggests future directions we might both consider if we (psychoanalysts and homosexuals) are to ever participate in mature object relations with one another.

When Is Transference Work Useful in Psychodynamic Psychotherapy? Main Results of the First Experimental Study of Transference Work (FEST)

This article presents the main results of the First Experimental Study of Transference (FEST). The background of the study, as well as the aims, main hypotheses, and methods are described. The participants were 100 patients who were randomized to psychodynamic psychotherapy of one year's duration, with transference work or without transference work. The analyses of the effects of psychodynamic psychotherapy with transference work versus psychodynamic psychotherapy without transference work are presented. The two treatments were equally effective, but analyses of moderators revealed differential effects. Patients with low quality of object relations (QOR) and/or presence of personality disorder showed specific positive effects of transference work. Female patients responded better than men. Further analyses included mechanisms of change and three-way interactions among factors, with an impact on outcome. We also found that (1) insight was a mediator of change, and (2) that the specific effects of transference work were influenced by interaction of object relations and alliance, but in the direct opposite direction of what is generally maintained in mainstream clinical theory. For patients with more mature object relations and high alliance, a negative effect of transference work was observed.

Self-concept and quality of object relations as predictors of outcome in short- and long-term psychotherapy

BackgroundQuality of object relations and self-concept reflect clinically relevant aspects of personality functioning, but their prediction as suitability factors for psychotherapies of different lengths has not been compared. This study compared their prediction on psychiatric symptoms and work ability in short- and long-term psychotherapy. MethodsAltogether 326 patients, 20–46 years of age, with mood and/or anxiety disorder, were randomized to short-term (solution-focused or short-term psychodynamic) psychotherapy and long-term psychodynamic psychotherapy. The Quality of Object Relations Scale (QORS) and the Structural Analysis of Social Behavior (SASB) self-concept questionnaire were measured at baseline, and their prediction on outcome during the 3-year follow-up was assessed by the Symptom Check List Global Severity Index and the Anxiety Scale, the Beck Depression Inventory and by the Work Ability Index, Social Adjustment Scale work subscale and the Perceived Psychological Functioning scale. ResultsNegative self-concept strongly and self-controlling characteristics modestly predicted better 3-year outcomes in long-term therapy, after faster early gains in short-term therapy. Patients with a more positive or self-emancipating self-concept, or more mature object relations, experienced more extensive benefits after long-term psychotherapy. LimitationsThe importance of length vs. long-term therapy technique on the differences found is not known. ConclusionsPatients with mild to moderate personality pathology, indicated by poor self-concept, seem to benefit more from long-term than short-term psychotherapy, in reducing risk of depression. Long-term therapy may also be indicated for patients with relatively good psychological functioning. More research is needed on the relative importance of these characteristics in comparison with other patient-related factors.

Effects of transference work in the context of therapeutic alliance and quality of object relations.

Transference interpretation is considered as a core active ingredient in dynamic psychotherapy. In common clinical theory, it is maintained that more mature relationships, as well as a strong therapeutic alliance, may be prerequisites for successful transference work. In this study, the interaction between quality of object relations, transference interpretation, and alliance is estimated. One hundred outpatients seeking psychotherapy for depression, anxiety, and personality disorders were randomly assigned to 1 year of weekly sessions of dynamic psychotherapy with transference interpretation or to the same type and duration of treatment, but without the use of transference interpretation. Quality of Object Relations (QOR)-lifelong pattern was evaluated before treatment (P. Høglend, 1994). The Working Alliance Inventory (A. O. Horvath & L. S. Greenberg, 1989; T. J. Tracey & A. M. Kokotovic, 1989) was rated in Session 7. The primary outcome variable was the Psychodynamic Functioning Scales (P. Høglend et al., 2000), measured at pretreatment, posttreatment, and 1 year after treatment termination. A significant Treatment Group × Quality of Object Relations × Alliance interaction was present, indicating that alliance had a significantly different impact on effects of transference interpretation, depending on the level of QOR. The impact of transference interpretation on psychodynamic functioning was more positive within the context of a weak therapeutic alliance for patients with low quality of object relations. For patients with more mature object relations and high alliance, the authors observed a negative effect of transference work. The specific effects of transference work was influenced by the interaction of object relations and alliance, but in the direct opposite direction of what is generally maintained in mainstream clinical theory.

Mental health quality and outcome measurement and improvement in Norway

To describe and discuss results from scientific articles in 2008-2009 on outcome and quality and improvement of these in the mental health services in Norway. Good outcome is documented for several types of interventions and patient groups such as information campaigns to reduce duration of untreated psychosis, dynamic psychotherapy with transference interpretations for patients with less mature object relations, group and individual therapy for patients with personality disorders, parent training to reduce conduct problems in small children and opioid maintenance treatment to reduce deaths from overdose. At the same time, there is a lack of adherence in clinicians' prescriptions of antipsychotic medication, in patients' use of medication and of integrated treatment for psychiatric disorders and substance abuse. General practitioners' rating of mental health services may be a more valid quality indicator than patients' satisfaction. There is a lack of studies on quality, treatment fidelity, service improvements and implementation of best practice. In spite of some documented treatments with good outcome, we know too little about the quality and outcome of the mental health services. Strategies for implementation of evidence-based treatment accompanied by research studies need to be the norm, not the exception.

Analysis of the Patient-Therapist Relationship in Dynamic Psychotherapy: An Experimental Study of Transference Interpretations

The purpose of this study was to measure the effects of transference interpretations (the assumed core active ingredient) in dynamic psychotherapy, using an experimental design. One hundred patients were randomly assigned to two groups. One group received dynamic psychotherapy over 1 year, with a moderate level of transference interpretations, while the other group received dynamic psychotherapy with no transference interpretations. The most common axis I disorders were depression and anxiety disorders. Forty-six patients fulfilled the general criteria for personality disorder. Seven experienced psychotherapists treated patients in both groups. Five full sessions from each treatment were rated by two evaluators with process measures in order to document treatment integrity. Outcome variables were the Psychodynamic Functioning Scales, Inventory of Interpersonal Problems Scale-Circumplex version, Global Assessment of Functioning Scale, and Symptom Checklist-90-R. Quality of Object Relations Scale (lifelong pattern) and personality disorders were preselected as possible moderators of treatment effects. Change was assessed using linear-mixed models. Clinically significant change was also calculated. The authors could not demonstrate differential treatment effects between the groups. However, the moderator analyses showed that transference interpretations were more helpful for patients with a lifelong history of less mature object relations. Small negative effects were observed for patients with mature object relations. The authors could not show differences in average effectiveness between treatments. However, the moderator analyses indicated that treatment worked through different active ingredients for different patients. Contrary to common expectation, patients with poor object relations profited more from therapy with transference interpretations than from therapy with no transference interpretations.

Object relations as a predictor of adjustment in conjugal bereavement.

The impact of object relations on adjustment in conjugal bereavement was examined. At approximately 6 months postbereavement, 46 midlife bereaved participants engaged in a narrative interview in which they were asked to discuss their past relationship with their deceased spouse. The Westen et al. object relations scoring system was applied to these narratives. Participants also completed depression and grief-specific symptom measures at 6 months and again at 14 and 25 months postbereavement. Object relations correlated differently with grief-specific symptoms and depression: it was more strongly negatively associated with 6 month postloss grief-specific symptoms while more strongly negatively correlated with depression at 25 month postloss. In a growth curve analysis, more mature object relations was also predictive of a faster rate of decrease in depression over time. The results were discussed in terms of current theoretical perspectives on what is required in successful adaptation to conjugal bereavement.

The Inner World of Objects and Lesbian Development

The central question explored by this study was whether or not evidence of mature object relations development could be found in a non-clinical sample of lesbians using measures of cognitive object relations. A non-clinical group of adult lesbians who reported positive identities were interviewed for comparison with the theoretical norm of object relations development in lesbians. The psychoanalytic literature supports the view that lesbians do not attain higher levels of object relations and have serious impairments in the level of object relations. These structural impairments indicate degrees of vulnerability to chronic depression and other forms of psychopathology. The article summarizes the relevant literature, and presents alternative data applicable to clinical assessment with lesbians.

Patient drawings and growth toward mature object relations: Observations of an art therapy group in a psychiatric ward

Sinrod (1964) notes that visual communication often precedes verbal communication. Consequently, working with a nonverbal modality, such as an art product, may be likely to facilitate a more rapid development of a therapeutic alliance and permit interpretation of problematic issues to occur earlier in treatment than the traditionally used therapies that are primarily verbal. In her remarkable book, Sechehaye (1951) presents an account of her work with a schizophrenic woman in which a cure for the patient’s illness was accomplished through the use of symbolic, nonverbal communications. The patient was developmentally fixated in a stage of primitive conflict related to the formation of the ego. Contact was established with the patient through symbolic satisfactions of a nonverbal nature which allowed the analyst to make further gains in her efforts to rebuild the patient’s personality. Nelsen (1975) also writes about symbolic communication and the importance of nonverbal communication in work with schizophrenic patients. More recently Waxer (1980) notes that there currently exists a genera1 interest in nonverbal behavior in the field of psychology. As he explains, present research efforts reflect what has long been observed clinically: there appears to be a relationship between how a person feels and the nonverbal behavior observed. Haley (1976) similarly writes on the subject of nonverbal communication in his discussion of the metaphorical aspects of analogic communication. Satir (1972) provides numerous examples of the interpersonal implications of nonverbal communications, and Waxer relates that nonverbal cues are a “more direct index of man’s inner condition than judgements based on written or spoken materials” (p. 955). Loesch (1980) defines nonverbalized feelings as “emotions or feelings which the individual is unable to put into words (for whatever reason) but which are being communicated nonetheless. even though the person may not be aware that they are being communicated” (p. 965). Vaccaro (1973) states that in some instances the art product may be the only “source of information regarding unconscious mechanisms available to the therapist” (p. 84). Sinrod (1964) additionally notes, “often unconscious material appears in pictures earlier than in purely verbal exchange” (p. 174). Elinor Ulman (1962) states that “pictured projections of unconscious material escape censorship more easily than do verbal expressions, so that the therapeutic process is

Psychological differentiation, self-concept, and object relations of adolescents as a function of family consensual types.

Thirty-three intact families consisting of an adolescent referred for psychotherapy, and a sibling adolescent, were classified according to the Reiss Card Sorting Test. All the families fit two of the types described by the theory of Reiss, the consensus sensitive and the distance sensitive; none were from the environment sensitive. Significant differences were found to exist between the adolescents in these two family types on personality measures. The adolescents from consensus-sensitive families showed a higher level of psychological differentiation, a higher self-concept, and more mature object relations than adolescents from the distance-sensitive families. The results verify and broaden aspects of Reiss' theory and are discussed in consideration with the development that has taken place in family therapy and research. They suggest that the relationship between the family and the adjustment of its children can be better understood and predicted on the basis of the family type.

Psychoanalytic Study of An Unusual Perversion

The psychoanalysis of a case of an unusual perversion demonstrated the historical determinants of the ritual. Drive and defense, bisexual disposition, and identifications were represented. At the beginning of the analysis the patient appeared to have borderline character traits; but as the analysis unfolded, an oedipal situation was revealed and character development occurred. The factors that determined the particular outcome for this patient, instead of homosexuality, or transsexualism, are discussed. In some cases of perversion, such as the one herein described, only psychoanalytic exploration can determine whether a level of personality structure and object relations had been reached that allows for the analysis of the perversion and a shift to heterosexuality and mature object relations.