Quality Of Object Relations Research Articles

Anksiyete Bozukluklarında Kişilik Örgütlenmesi: Yaygın Anksiyete Bozukluğu ve Panik Bozukluğu Karşılaştırılması

The objective of this study was to explore the level of personality organization in patients diagnosed with generalized anxiety disorder (GAD) and panic disorder (PD). The study comprised 86 patients undergoing treatment for GAD (n=46) and PD (n=40). Various tools were utilized for data collection including a Sociodemographic Data Collection Form, Personality Organization Diagnostic Form (PODF), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A significant difference was observed between the GAD and PD groups regarding the PODF scores for mature defense, anxiety, and depression. However, no significant difference was observed in relation to the PODF identity total score and primitive defense scores. Furthermore, the quality of object relations and the overall level of personality organization according to the PODF did not display any significant differences between the groups. According to the BDI, comorbid depressive symptoms were detected in 67.4% (n=58) of the participants with GAD and PD. There was no significant difference in the PODF scores, quality of object relations, and the overall level of personality organization between the group with comorbid depressive symptoms and the group without it.These findings suggest that while the primary focus of therapeutic interventions should be on targeting the specific type of anxiety disorder, assessing the level of personality organization in patients with GAD and PD could add valuable insights to individual case understanding, selection of psychotherapy approaches, and the treatment process..

Object Relations–Informed Psychotherapy: Introduction to Festschrift Honoring Otto F. Kernberg, M.D.

Object Relations–Informed Psychotherapy: Introduction to Festschrift Honoring Otto F. Kernberg, M.D.

THE EFFECTIVENESS OF SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPY IN DEPRESSION AND ANXIETY DISORDERS

ABSTRACT Short-term psychodynamic psychotherapy (STPP) is a treatment modality for depressive disorder, anxiety disorder, and personality disorders. In this study, we aimed to assess the effectiveness of the STPP programme in patients with depression and anxiety who were partially responsive to previous treatments. Participants were consisted of 36 patients, 27 of whom were female and 9 were male. A total of 12 sessions of STPP were applied to the patients included in the study, sessions lasting 45 minutes, every 2 weeks, for 6 months. During the STPP procedure, the nature of unconscious conflicts was tried to be understood. The quality of object relations and defence mechanisms were evaluated. The elements of resistance, transference, and counter-transference were examined. Psychodynamic formulation was formed. Treatment goals were determined together with the patient. In this direction, psychotherapeutic strategies have been developed. We evaluated pre- and post-treatment effectiveness according to clinical variables and also the change in self-destructive behaviours. Scales measuring their psychiatric status were administered at base-line, pre-and post-treatment. The primary outcome measures were depression and anxiety scores. At the end of STPP, depression, and anxiety scores were all significantly decreased. A significant improvement was observed in 94% of our patients who could not achieve adequate improvement with previous treatment interventions. During the psychotherapy process, none of the patients attempted suicide and there was a significant decrease in self-destructive behaviours. These findings suggest that STPP is an effective treatment in patients with anxiety disorders and depression, who have not achieved adequate response to previous standard psychiatric treatments.

Borderline personality disorder as asyndrome of poor quality of object relations

Objective: Interpersonal dysfunction is a hallmark feature of borderline personality disorder (BPD). Representing lifelong relational patterns based in internal representations, quality of object relations (QOR) has been theorized as a core aspect of borderline personality pathology; yet empirical inquiry of this relationship has been limited. The present study investigated the association between QOR and BPD in the context of other salient correlates of BPD. Method: Participants were 137 outpatients obtaining care at an intensive treatment program for patients with personality dysfunction. BPD was assessed using two interview-based instruments. A separate interviewer-rated assessment of quality of object relations was administered by a different set of assessors. Participants also completed self-report measures of symptom distress, five-factor personality, and dysphoric affects. Results: Regarding BPD severity, QOR emerged as the only significant predictor with all variables in the model. Similarly, logistic regression found that QOR was associated with a significantly greater likelihood of having a diagnosis of BPD, after accounting for the effects of the other variables in the model. Conclusion: QOR is significantly and uniquely associated with BPD, suggesting that internalized representations of self and others play an important role underlying BPD pathology.

Therapeutic Atmosphere in Psychotherapy Sessions.

There is uncertainty concerning what the active ingredients in psychotherapy are. The First Experimental Study of Transference interpretations (FEST) was a randomized controlled trial of the effects of transference work (TW) in psychodynamic psychotherapy. Women with low quality of object relations (QOR) showed a large positive effect of transference work, while men with high QOR showed a slight negative effect. The present study aimed to expand the knowledge from the FEST by investigating the therapeutic atmosphere with Structural Analysis of Social Behavior (SASB). Two-way ANOVAs were conducted to investigate differences between SASB cluster scores between subgroups. The therapeutic atmosphere was characterized by Protect–Trust, Affirm–Disclose and Control–Submit. Multilevel modeling was used to assess the relationship between a therapist variable and outcomes for men and women. Contrary to expectations, no significant differences in therapeutic atmosphere between subgroups (with or without TW in women with low QOR and men with high QOR) were observed using the process measure SASB.

Narcissism and Quality of Life

Pathological narcissism is associated with decreased quality of life, even when accounting for psychiatric comorbidity, but the processes behind this association are unclear. Here, we evaluate whether disturbed relatedness accounts for the negative association between narcissistic pathology and quality of life. Patients in day hospital treatment for personality pathology (N = 218, 70% female; mean age, 37.3 years) completed measures of personality disorder features, quality of life, and global symptoms before beginning treatment. Quality of object relations was assessed through semistructured interviews. Regression-based mediation analyses showed that narcissistic personality traits relate to quality of life through quality of object relations, controlling for other personality disorders and psychiatric distress. These results highlight the importance of problematic relationship patterns for the low quality of life associated with pathological narcissism. Clinicians working with narcissistic individuals should consider psychotherapies that promote mature relatedness and should attend to facilitating the quality of patients' relationships.

Patient Extratherapeutic Interpersonal Problems and Response to Psychotherapy for Depression.

This paper aimed to synthesize empirical findings of patient extratherapeutic interpersonal variables associated with individual psychotherapy treatment outcomes in adult outpatients with depression. A systematic search strategy was used to identify relevant studies. Thematic analysis was used to identify recurring themes in the findings. Forty studies met search criteria. Three themes of patient extratherapeutic interpersonal variables were identified: capacity to engage with others, capacity to navigate relationships, and capacity to achieve intimacy, progressing from basic to advanced levels of interpersonal interaction. Interpersonal variables such as interpersonal distress and style, attachment orientation, and quality of object relations were particularly useful in predicting treatment outcomes, whereas access to social support and marital status provided mixed results, likely because they do not account for relationship quality. Recognizing variables associated with treatment response can help clinicians identify patients at risk for nonresponse and guide efforts for adapting existing therapies and developing new ones.

Quality of object relations and suicidal ideation among community mental health outpatients

Patients in community mental health settings frequently endorse suicidal thoughts. While a variety of factors may be involved, the role of impaired quality of object relations– structuralized representations of self-other relationships – may significantly contribute to the likelihood of experiencing suicidal ideation. The present study examined the association between current suicidal thoughts and quality of object relations impairment in a sample of 101 patients presenting for community mental health services. Logistic regression analysis indicated that overall impairment of quality of object relations was significantly associated with current suicidal thoughts after controlling for past suicide attempts and severity of psychiatric symptoms. Individuals with highly impaired quality of object relations had a nearly two-and-a-half times greater likelihood of reporting current suicidal thoughts.

Improving self-esteem through integrative group therapy for personality dysfunction: Investigating the role of the therapeutic alliance and quality of object relations.

We aimed to investigate change in self-esteem through intensive group treatment for personality dysfunction, by exploring: (a) the relationship between patients' experience of therapeutic alliance and improvement in self-esteem during treatment, including patients' quality of object-relations (QOR) as a possible moderator; and (b) the association between improvement in self-esteem during treatment, and depressive symptoms 9 months later. Eighty patients with personality dysfunction, consecutively enrolled in a group-oriented treatment program, were assessed at pretreatment, posttreatment, and 9 months follow-up. Especially for patients with lower QOR, alliance predicted self-esteem change during treatment. In addition, change in self-esteem during treatment predicted follow-up depression severity, even when controlling for within-treatment symptom change. Patients with impoverished inner relational representations may benefit more from a secure alliance in terms of improving their self-esteem. Change in self-esteem may also be important in preventing relapse of depressive symptoms in people with personality dysfunction.

Panic-Focused Reflective Functioning and Comorbid Borderline Traits as Predictors of Change in Quality of Object Relations in Panic Disorder Treatments.

To investigate whether (a) baseline levels of panic-specific reflection function (PSRF; i.e. patients' capacity to reflect on their panic symptoms) and improvement in this capacity over treatment; (b) baseline borderline personality disorder (BPD) traits and pre-post treatment improvement in BPD traits predict change in patients' quality of object relations. A subsample of 102 patients diagnosed with panic disorder from a larger randomized controlled trial received either Cognitive-Behavioral Therapy or Panic-Focused Psychodynamic Psychotherapy. We investigated whether baseline levels and change in both PSRF and BPD traits (as measured by the SCID-II) predicted pre-post change in quality of object relations (QOR), while controlling for pre-post treatment change in panic symptoms assessed by the Panic Disorder Severity Scale. In both treatments, higher baseline levels of PSRF and lower levels of BPD traits, as well as pre-post decrease in BPD traits, predicted improvement in QOR when controlling for symptomatic change. The findings suggest that reduction in comorbid BPD traits can facilitate improvement in patients' quality of object relations even in brief symptom-focused psychotherapies. Additionally, patients with higher baseline levels of symptom-focused reflective function and lower BPD traits are more likely to demonstrate interpersonal change over the course of psychotherapy for panic disorder. Finally, our study highlights the importance of examining therapeutic change beyond reduction in symptoms, particularly in domains of interpersonal functioning.

Quality of Internalized Object Representations and Suicidality in Individuals With Anaclitic and Introjective Personality Styles.

Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interpersonal correlates of suicidality in 124 patients attending residential treatment for complex psychiatric disorders, with the aim of clarifying how social cognition and quality of internalized object representations relate to suicidality in individuals with anaclitic versus introjective personality organizations. Higher anaclitic and lower introjective traits each predicted higher frequency of prior attempts. Furthermore, higher anaclitic and lower introjective traits interacted with the affective-interpersonal quality of object representations to predict prior attempts, such that each trait was associated with more frequent past attempts in the context of poorer quality of object relations. The treatment implications of these findings are discussed, and areas for future research are considered.

Flexibility and Rigidity in Object Relational Functioning: Assessing Change in Suicidal Ideation and Global Psychiatric Functioning Using the SCORS–G

ABSTRACTThe Social Cognition and Object Relations Scale–Global Rating Method (SCORS–G; Westen, 1995) has been widely used as an assessment measure of object relational functioning across a number of stimuli. This study used the SCORS–G to investigate associations between global impairments and rigidity in quality of object relations with changes in suicidal ideation and psychiatric functioning over time. Participant narratives describing actual interpersonal experiences were collected using the Relationship Anecdote Paradigm (Luborsky, 1998) from a sample of individuals diagnosed with complex psychopathology completing residential psychiatric treatment. We found that a greater range in affective quality and emotional investment in relationship scores at admission into treatment were significantly related to a reduction in suicidal ideation as well as improvements in global psychiatric functioning at 5-year follow-up. Thus, participants who acknowledged having both healthy as well as troubled relationships in their daily lives were less suicidal and less likely to experience disruptive psychiatric symptoms over time than those who described more restricted or uniform relational experiences on entering treatment. Implications for calculating range scores and using various narrative techniques when applying the SCORS–G method are discussed.

Does Therapists' Disengaged Feelings Influence the Effect of Transference Work? A Study on Countertransference.

Therapists' emotional reactions to their patients (countertransference) seem to have a significant impact on both the treatment process and outcome of psychotherapy. Therapists' heightened level of disengaged feelings over a treatment period shows an adverse impact on the effect of transference work for all patients, and especially so for patients with a history of poor, non-mutual and complicated relationships. For patients with a history of reciprocal, sound relationships the negative influence of therapists' disengaged countertransference is minimal. Higher therapist disengagement is strongly related to inferior therapists' skill for patients with a history of poor relationships and/or more personality disorder pathology. Training and supervision should provide direct feedback and focus on therapists' internal thought processes and emotional reactions. Therapists need to recognize and understand their feelings and attitudes in order to use the countertransference as a tool to understand the interpersonal process in therapy.

The quality of mother-child relationship and borderline personality: The role of mediator object relations

Aim: Borderline personality characterized by the instability of interpersonal relationships, self-concept and mood swings is one the most common disorders in clinical settings. Scholars theorizing on object relations, as pioneers of borderline personality, consider borderline personality as a result of childhood trauma, and associated with initial objects. The present paper aims to explain the structural model of borderline personality based upon the quality of mother-child relationships through the mediator role of object relations. Methods: A total of 402 students (184 males and 218 females) at Islamic Azad University of Qom and University of Qom in the first semester of 2013–2014 were selected by stratified random sampling. They completed Borderline Personality Inventory, Bell Object Relations Inventory, and Parent-Child Relationship Scale–Mother. The data were analyzed using SPSS, LISREL, Cronbach's alpha coefficients, exploratory factor analysis, confirmatory factor analysis, and structural equation modeling. Results: The quality of the mother-child relationship directly explains 1.44% and through mediating object relations 14.31%, and a total of 15.75% of the variance of borderline personality. Conclusion: Based on these results, the quality of object relations plays a crucial role in mediating mother-child relationship and borderline personality.

Structured Interview of Personality Organization (STIPO) – Czech Version Validation Study as an Optional Approach to Research Testing of the “Katathym Imaginative Psychotherapie” (KIP) Effectiveness

The Alternative Model for Personality Disorders (AMPD) is the key contribution to the classification of Personality Disorders (PD) in the current DSM-5 proposal. The shift from the assessment of PD symptomatic criteria to the assessment of the dimensional basis of personality psychopathology reflects considerably in planning of the therapeutic procedures and evaluation of the treatment effectiveness. Structured Interview of Personality Organization (STIPO) offers a psychodynamic tool to assess personality organization, that is the level of personality functioning, according to the Kernberg’s model of personality psychopathology. STIPO comprises seven dimensions: (1) Identity; (2) Quality of Object Relations; (3) Primitive Defenses; (4) Coping/Rigidity; (5) Aggression; (6) Moral Values; (7) Reality Testing and Perceptual Distortions. These dimensions help assess the level of the subject’s adaptive functioning, as well as the extent to which everyday functioning is conditioned by early maladaptive patterns. This article focuses on the importance of the structural diagnostics from the perspective of “Katathym-Imaginative Psychotherapie” (KIP). We describe the origins of the STIPO method and, in a case study, we demonstrate its clinical significance for making decisions about applicability of imaginative techniques in treatment of PD clients. Finally, we mention the importance of the validation study of the Czech STIPO version, which appears to be a useful tool of research testing of KIP effectiveness.

Borderline Personality Disorder in Adolescence Through the Lens of the Interview of Personality Organization Processes in Adolescence (IPOP-A): Clinical Use and Implications

Borderline personality disorder can be assessed in adolescence mainly through a dimensional approach that takes into account strengths and weaknesses of emerging personality patterns. Clinical interviews could help clinicians to gather information about adolescent’s functioning, fostering therapeutic alliance and promoting a mentalizing stance during the assessment of borderline adolescents. In this article, the Interview of Personality Organization Processes in Adolescence (IPOP-A) is presented through clinical case material to show its usefulness in clinical and research settings. The IPOP-A assesses an adolescent’s emerging personality along three dimensions: identity, quality of object relations and affect regulation. These dimensions are the core of borderline personality in adolescence.

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.

Relationship between Two Dimensions of Object Relations and Group Psychotherapy Attendance Rate in Borderline Personality Disorder Individuals

Aim: Recent studies showed that the quality of object relations in patients with personality disorders predict individual psychotherapy attendance rate. However, associations between these variables have led to inconsistent results for group psychotherapy. The aim of the present study was to verify whether two dimensions of object relations are associated with rates of attendance at group psychotherapy sessions. Methods: Thematic Apperception Test narratives of forty-one outpatients with borderline personality disorder (BPD) enrolled in a psychodynamic group therapy over a period of one year were rated on two variables of the Social Cognition and Object Relations Scale (SCORS): affective quality of representations and emotional investment in relationship. Results: Results indicated that these two affective dimensions of object relations were positively correlated with rate of attendance at group psychotherapy sessions after controlling for age of the participant. Conclusion: These results suggest that the quality of object relations could be a potential predictor for group therapy attendance. The results are discussed by taking into account the particular aspects of relational issues in group psychotherapy as opposed to individual psychotherapy.

Clinical correlates of alexithymia among patients with personality disorder

The literature portrays patients with alexithymia as unusual and difficult to treat; research to date has not clarified the nature of this condition. This study addressed associations between alexithymia and constructs relevant to clinical intervention, namely attachment, quality of object relations, emotion regulation, defense style, personality disorder, and treatment outcome. Fifty-one patients admitted to an intensive group-oriented day treatment program were recruited. Prior to therapy, patients were administered self-report and structured interview measures of predictor and outcome variables; outcome measures were re-administered at completion of the 18-week program. Alexithymia was common in this sample, with four of five patients endorsing moderate or greater problems. Associations with attachment avoidance, primitive object relations, suppression of emotional expression, use of immature defenses, and severity of borderline personality disorder were identified. Alexithymia did not, however, predict outcome. Findings are considered in terms of how the construct informs views of personality disorder.

Treatment of adolescents with depression: the effect of transference interventions in a randomized controlled study of dynamic psychotherapy.

BackgroundDepression in adolescents seems to be a growing problem that causes mental suffering and prevents young people from joining the workforce. There is also a high risk of relapse during adult life. There is emerging evidence for the effect of psychodynamic psychotherapy in adolescents. In-session relational intervention (that is, transference intervention) is a key component of psychodynamic psychotherapy. However, whether depressed adolescents profit most from psychodynamic psychotherapy with or without transference interventions has not been stated.ObjectThe effect of transference interventions in depressed adolescents and the moderator moderating effect of quality of object relations, personality disorder and gender will be explored.Methods and study designThe First Experimental Study of Transference Work–In Teenagers (FEST–IT) will be a randomized clinical trial with a dismantling design. The study is aimed to explore the effects of transference work in psychodynamic psychotherapy for adolescents with depression. One hundred patients ages 16 to 18 years old will be randomized to one of two treatment groups, in both of which general psychodynamic techniques will be used. The patients will be treated over 28 weeks with either a moderate level of transference intervention or no transference intervention. Follow-up will be at 1 year after treatment termination. The outcome measures will be the Psychodynamic Functioning Scales (PFS), Inventory of Interpersonal Problems–Circumplex Version (IIP-C), Global Assessment of Functioning (GAF), and the total mean score of Symptom Checklist–90 (Global Severity Index; GSI), Beck Depression Inventory (BDI), and Montgomery Åsberg Rating Scale (MADRS). The quality of adolescents’ relationships will be a central focus of the study, and the Adolescent Relationship Scales (ARS) and Differentiation–Relatedness Scale (DRS) will also be used. Change will be assessed using linear-mixed models. Gender personality disorder (PD) and quality of object relations (QOR) will be the preselected putative moderators.DiscussionThe object of this clinical trial is to explore the effect of transference interventions in psychodynamic psychotherapy in adolescents with a major depressive disorder. Using a randomized and dismantling design, we hope that the study will add more specific knowledge to the evidence base.Trial registrationClinicalTrials.gov Identifier: NCT01531101First Experimental Study of Transference work Work–In Teenagers (FEST-IT)