Mental Representation, Severe Psychopathology, and the Therapeutic Process

Abstract

Mental representation is a central construct in psychological development. A method for assessing the developmental level of representation of self and significant figures is described, and changes in the developmental level of these representations are reported in a sample of forty seriously disturbed, treatment-resistant adolescents and young adults in intensive, psychoanalytically oriented inpatient treatment lasting more than a year. Increased differentiation-relatedness of descriptions of self and significant figures (mother, father, and therapist) was significantly correlated with improved clinical functioning. Over the course of treatment, representations moved from descriptions of self and significant figures dominated by polarization and splitting to representations involving the emergence and consolidation of object constancy. Improved clinical functioning was correlated with more positive descriptions of self, mother, and therapist and, paradoxically, with more negative descriptions of father. Two prototypical case studies of these self- and significant-figure descriptions are presented, one for a borderline patient and one for a schizophrenic. Intense negative affect, predominantly anger, and a relative preservation of self-reflexivity are typical of the self- and object representations of borderline individuals, but representations in schizophrenic individuals are characterized by affective muting and marked disturbance in reflexive self-awareness. The assessment of cognitive-affective schemas of self and significant others provides a method for investigating therapeutic change and for identifying important differences among various forms of psychopathology.

Parental object representations, attachment to God, and recovery among individuals with psychosis

“…The benevolent factor is composed of attributes of affectionate, benevolent, warm, constructive involvement, positive ideal, nurturant, successful, and strong. The punitive factor includes the attributes judgemental, punitive, and ambivalent (Blatt & Auerbach, 2001). Interrater reliability on the first round of scores (prior to the consensus meetings) was measured with an intraclass correlation, two-way random effects model (Shrout & Fleiss, 1979).…”

Trauma, Dissociation and Synthetic Metacognition in Schizophrenia

“…After Bleuler the concept of schizophrenic splitting was elaborated by other authors mainly from the circle of psychoanalysts with a conclusion that it has a form of fragmentation where splits occurs simultaneously (fractured actions, affects, raw drives, perceptions, memories and fantasy elaborations), lacks reality testing as well as identification of subjectivity (Blatt & Auerbach, 2001;Lustman, 1977). It is linked to inability to appropriately differentiate and distinguish between self and non-self as an agent of an internal experience (Anzieu, 1993;Bion, 1957;Bleger, 1974;Ogden, 1989).…”

Self-Other Representations Mediate the Relationship Between Five-Factor Model Depression and Depressive States

“…In fact, many treatment approaches are built on the premise that object relations and interpersonal dysfunction are the most appropriate targets of treatment and are essential to address in conducting effective psychotherapy (Benjamin, 2003;Clarkin & Levy, 2003;Horowitz, 2004;Huprich, 2009;Kiesler, 1996;Leichsenring & Leibing, 2003;Shedler, 2010). The psychodynamic literature is replete with theoretical descriptions and empirical findings of the relationship between problematic object relations and psychopathology (e.g., Blatt & Auerbach, 2001;Blatt, Auerbach, & Levy, 1997;Blatt & Luyten, 2010;Clarkin, Lenzenweger, Yeomans, Levy, & Kernberg, 2007;Greenberg & Mitchell, 1983;Huprich & Greenberg, 2003;Kernberg, 1988Kernberg, , 1995Mitchell, 1988;Porcerelli, Huprich, Karana, & Binienda, 2006). In a review paper of several extant measures of object relations, one of the most consistent findings reported by Huprich and Greenberg (2003) was that more impaired object relations are associated with various kinds of psychopathology.…”