Facets of Object Representation: Process and Outcome Over the Course of Psychodynamic Psychotherapy

This study explores the effectiveness of psychodynamic psychotherapy in improving facets of object relations (OR) functioning over the course of treatment. The sample consisted of 75 outpatients engaged in short-term dynamic psychotherapy at a university-based psychological services clinic. Facets of OR functioning were assessed at pre- and posttreatment by independent raters using the Social Cognition and Object Relations Scale-Global rating method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011; Westen, 1995) from in-session patient relational narratives. The Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman, Bonge, & Blais, 2005) was used to assess therapist activity and psychotherapy techniques early in treatment. Independent clinical ratings of OR functioning and psychotherapy technique were conducted and all were found to be in the good to excellent range of reliability. Specific facets of OR functioning improved with medium to large effect changes posttreatment. These adaptive changes were significantly related to the incidence of psychodynamic-interpersonal (PI) techniques. Also, this study identified the role specific psychodynamic techniques had in facilitating change in a number of underlying dimensions of OR. Patient self-reported reliable change in symptomatology and reliable change in facets of OR were significantly related as well. This study highlights the utility of incorporating psychological assessment into psychotherapy practice to assess change at the explicit (symptoms) and implicit (OR) level. Limitations of this study, future research directions, and implications for clinical practice are discussed.