Quality of object representations related to service utilization in a long-term residential treatment center

The current study examines patient factors related to service utilization during intensive treatment for 66 residential patients suffering from severe mental illness. We examined the relationship among demographic, psychiatric severity, and quality of object representation variables with individual and group psychotherapy sessions attended and emergency department transfers. Hierarchical linear regression models indicate malevolent affective expectations of interpersonal relationships embedded in patient narratives is uniquely related to individual psychotherapy attendance. A three-variable model consisting of higher educational status, number of axis I/II disorders, and poor understanding of social causality was related to transfers to emergency departments owing to self-destructive behavior. Quality of object representation of self and others was uniquely related to treatment use and self-destructive behaviors. Results highlight the importance of a comprehensive multimodal evaluation for improving treatment preparation, planning, and intervention. Clinical implications are considered.