Relationship Between Patient Pre‐treatment Object Relations Functioning and Psychodynamic Techniques Early in Treatment

Abstract

Consider more frequent use of psychodynamic techniques early in treatment with patients expressing more pathological object representations, particularly when these deficits are in the affective and identity domains. Lower patient object relations functioning may necessitate an in session focus on issues that are avoided or uncomfortable early in treatment. Lower patient object relations functioning may necessitate the need to address and explore labile affective expressions in session as they occur early in treatment. When patients are able to more adaptively express or manage aggressive impulses early within psychodynamic psychotherapy consider the integration of problem solving, goal oriented, future focused (i.e., CB) techniques.

Object representation quality, therapeutic alliance, and psychotherapy process

“…Our findings regarding higher utilization of psychodynamic rather than cognitive-behavioral techniques with patients displaying higher levels of disturbance in terms of their object relations are consistent with previous findings using a subsample with a different measure of object relations rated using narratives expressed during psychotherapy (Mullin & Hilsenroth, 2014). Exploratory analysis reveals that specific techniques used represent a combination of interpretive interventions (e.g., "The therapist focuses attention on similarities among the patient's relationships repeated over time, settings, or people" and "The therapist identifies recurrent patterns in the patient's actions, feelings, and experiences") and experiential/expressive interventions (e.g., "The therapist focuses discussion on the relationship between the therapist and patient").…”

“…Previous studies (Ackerman, Hilsenroth, Clemence, et al, 2000;Mullin & Hilsenroth, 2014;Siefert et al, 2006) also suggest that perhaps patients with disturbed object relations might create a "pull" for the utilization of certain psychodynamic techniques. Based on the current study, it appears that difficulties with mutuality and expectations of malevolence might call for a variety of interpretive and experiential techniques where patient and therapist engage in an exploration of relationships, including the therapeutic relationship.…”

“…In a recent study, Mullin and Hilsenroth (2014) reported that when working with patients with less adaptive object relations functioning in terms of affective quality of object representations, self-esteem, and coherence of self, therapists on average used more psychodynamic techniques as opposed to cognitive-behavioral techniques. They also reported that a specific psychodynamic technique-"The therapist addresses the patient's avoidance of important topics and shifts in mood"-correlated with less adaptive affective quality of object representations, emotional investment in relationships, understanding of social causality, self-esteem, coherence of self, and overall object relations functioning as measured by the SCORS-G.…”

The prediction of the level of personality organization on reduction of psychiatric symptoms and improvement of work ability in short‐ versus long‐term psychotherapies during a 5‐year follow‐up

“…The lack of more rapid benefits in short‐term therapies with the patients with higher level borderline personality organization is consistent with clinical views highlighting that patients in the borderline personality range tend to have greater rigidity of defences and to have more discontinuous and inflexible relationships as specific challenges, requiring a lengthy treatment process (Caligor et al ., ). This is also supported by studies showing that early in treatment the formation of a basic connection and alliance requires significantly more focusing and may be more deficient than in patients with more mature personality organization (Diener & Monroe, ; Mullin & Hilsenroth, ).…”

Changes in Object Relations over the Course of Psychodynamic Psychotherapy

“…Within the subsample of these patients, certain techniques have been related to multiple changes across treatment and specifically were positively related to changes in depression and anxiety symptoms (Hilsenroth, Ackerman, Blagys, Baity, & Mooney, ; Hilsenroth, ; Pitman, Slavin‐Mulford, & Hilsenroth, ). More recently, Mullin and Hilsenroth, reported data on specific SCORS subscales in relation to use of psychodynamic–interpersonal (PI) techniques early in treatment. Global OR functioning at pre‐treatment was not significantly related to overall use of PI techniques.…”