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Porcerelli, J.H. Shahar, G. Blatt, S.J. Ford, R.Q. Mezza, J.A. Greenlee, L.M. (2005). Abstracts of the 2005 Poster Session of the American Psychoanalytic Association Winter Meeting: Changes in Object Relations Following Intensive Psychoanalytically Oriented Inpatient Treatment. J. Amer. Psychoanal. Assn., 53(4):1323-1325.
Psychoanalytic Electronic Publishing: Abstracts of the 2005 Poster Session of the American Psychoanalytic Association Winter Meeting: Changes in Object Relations Following Intensive Psychoanalytically Oriented Inpatient Treatment
(2005). Journal of the American Psychoanalytic Association, 53(4):1323-1325
Considerable advances have been made in recent years in the assessment of mental representations. One of the most reliable and valid measures of mental representations is the Social Cognition and Object Relations Scale (Westen et al. 1990). The present study used data from the Riggs-Yale Project (Blatt and Ford 1994) to assess changes in mental representations following intensive inpatient psychoanalytically oriented treatment of severely disturbed, treatment-resistant patients.
Participants and Procedures
The study included 84 patients (mean age = 21). Patients received, on average, 1.5 years of psychoanalytically oriented treatment and had undergone psychological testing at admission and at the end of the study period. Most patients were at least middle-class, with at least average IQs. Approximately 30% were diagnosed with a DSM-III psychotic condition. Object relations were coded from six TAT cards (1, 5, 12 M, 13 MF, 14, 15).
The Social Cognition and Object Relations Scale (SCORS) includes four dimensions of object relations, each scored on a 5-point scale with scores of 5 being healthy. Complexity of Representations (CR) assesses degree of differentiation, integration and complexity. Affect-tone of Relationships (AT) assesses malevolence (vs. benevolence) of relationships. Capacity for Emotional Investment (EI) assesses the degree of need-gratifying vs. mutual relatedness. Understanding Social Causality (SC) assesses the degree to which social attributions are logical, accurate, and psychologically minded.
Interrater reliability using intraclass correlations (Shrout and Fleiss 1979) of the SCORS ranged from.73 to.84. Repeated measures MANOVAs
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comparing SCORS ratings at the outset and after 15 months of treatment were significant, F(4,80) = 9.50, p <.001. Results of the univariate ANOVAs were significant at the p <.001 level for AT, EI, and SC, and at the p <.05 level for CR. Effect sizes (Cohen 1988) were.30 (CR),.72 (AT),.51 (EI), and.44 (SC).
Significant changes in object relations were demonstrated following psychoanalytically oriented inpatient treatment. These findings are consistent with other Riggs-Yale Project studies of object relations changes that used related measures (Blatt and Ford 1994; Fertuck et al. 2004; Rosenberg et al. 1994). Following treatment, descriptions of relationships were less malevolent, idiosyncratic, and illogical and showed more mutuality, complexity, and psychological mindedness. Overall, these results suggest structural changes could occur in a population of severely disturbed, treatment-resistant patients following intensive psychoanalytically oriented inpatient treatment. This study supports a growing literature demonstrating the value of intensive long-term psychoanalytically oriented treatment and the importance of assessing mental representations in treatment outcome studies (Blatt and Auerbach 2003).
Limitations of this study include a modest sample size, which restricts statistical power, and the availability of only two assessment points, which prevented the examination of growth trajectories in object relations.
BLATT, S.J. & FORD, R.Q. (1994). Therapeutic Change: An Object Relations Perspective. New York: Plenum Press. [→]
COHEN, J. (1988). Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Erlbaum.
FERTUCK, E.A., BUCCI, W., BLATT, S.J., & FORD, R.Q. (2004). Verbal representations and therapeutic change in anaclitic and introjective patients. Psychotherapy: Theory, Research, Practice & Training 41: 13-25. [Related→]
ROSENBERG, S.D., BLATT, S.J., OXMAN, T.E., MCHUGO, G.J., & FORD, R.Q. (1994). Assessment of object relatedness through a lexical content analysis of the TAT. Journal of Personality Assessment 63: 345-362.
Porcerelli, J.H., Shahar, G., Blatt, S.J., Ford, R.Q., Mezza, J.A. and Greenlee, L.M. (2005). Abstracts of the 2005 Poster Session of the American Psychoanalytic Association Winter Meeting. J. Amer. Psychoanal. Assn., 53(4):1323-1325