Intrapsychic and symptomatic change in patients with borderline psychopathology.
Item
-
Title
-
Intrapsychic and symptomatic change in patients with borderline psychopathology.
-
Identifier
-
AAI3037414
-
identifier
-
3037414
-
Creator
-
Levine, Hilary Anne.
-
Contributor
-
Adviser: Diana Diamond
-
Date
-
2002
-
Language
-
English
-
Publisher
-
City University of New York.
-
Subject
-
Psychology, Clinical
-
Abstract
-
This dissertation combined case-study methodology with empirically validated baseline and outcome measures to document both intrapsychic and symptomatic change in borderline patients treated with Transference Focused Psychotherapy for one year. It was designed to be a preliminary investigation of the effectiveness of this treatment in bringing about changes in character structure, specifically, object relations, characteristic defensive styles, mental representations of attachment, and the capacity for reflection about oneself and others.;Two patients with borderline personality disorder in treatment with the same therapist, but with different attachment classifications were chosen for this study. The patients' attachment statuses were re-assessed after one year using the Adult Attachment Interview. The patients' capacities for reflective function and the level of their differentiation and relatedness were assessed using the Reflective Function Scale and the Object Representation Inventory. At four-month intervals, randomly selected psychotherapy sessions were coded with the Defense Mechanism Rating Scales to assess the patients' use of defense mechanisms throughout the year. In addition, assessments of the patients' symptomatology occurred at four-month intervals using self-report measures, including: the Beck Depression Inventory, the Brief Symptom Index, and the State-Trait Anger Expression Inventory. Throughout the treatment, the patients tracked their symptomatic behavior and rated their urges to self-harm and quit treatment. Each of the factors hypothesized by Otto Kernberg to discriminate between levels of personality organization (i.e., primitive defenses, identity diffusion, and reality testing) were assessed with the Inventory of Personality Organization. At the end of the year, the patients and therapist were interviewed with the Patient-Therapist Adult Attachment Interview and asked to reflect upon his or her experience of the other during the treatment process.;Both patients were rated as having shifted from insecure to secure states of mind with respect to attachment and experienced a significant reduction in their levels of distress and in their self-destructive behavior after one year of treatment. On other measures their trajectories of change were quite different from one another. The findings underscore the importance of using multiple measures in evaluating clinical process and outcome. In addition, the findings highlight the role of attachment in determining the course of treatment, the quality of the alliance, and the types and direction of change one would expect to see in a psychodynamic treatment.
-
Type
-
dissertation
-
Source
-
PQT Legacy CUNY.xlsx
-
degree
-
Ph.D.
