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Horner, M.S. Diamond, D. (1996). Object Relations Development and Psychotherapy Dropout in Borderline Outpatients. Psychoanal. Psychol., 13(2):205-223.

(1996). Psychoanalytic Psychology, 13(2):205-223

Object Relations Development and Psychotherapy Dropout in Borderline Outpatients

Mark S. Horner, Ph.D. and Diana Diamond, Ph.D.

Using Rorschach object relations measures, we sought to identify patterns of object representations in borderline outpatients that would distinguish those at risk for premature termination from those likely to continue in expressive psychodynamic psychotherapy. In this exploratory pilot study, patients who dropped out of treatment in the Cornell Borderline Psychotherapy Research Project (Kernberg, Selzer, Koenigsberg, Carr, & Appelbaum, 1989; Yeomans, Selzer, & Clarkin, 1993; Yeomans et al., 1994) showed a predominance of narcissistic themes in their Rorschach responses at the outset of treatment, as scored by the Rorschach SeparationIndividuation Scale (S–I Scale; Coonerty, Diamond, Kaslow, & Blatt, 1987). Whereas those who continued in treatment were characterized by a relatively even ratio of narcissism to higher-level rapprochement themes on the S–I Scale, psychotherapy dropouts produced almost 4 times as many narcissism as rapprochement themes. Moreover, subjects who completed treatment were typified by a relatively even distribution of scores across all separationindividuation subphases, in contrast to the predominance of narcissism themes in the records of dropouts. These Rorschach findings were reflected in ratings of psychotherapy transcripts. Results are discussed in light of object relations theory.

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