Relationship between patient pre-treatment object relations functioning and psychodynamic techniques early in...

This study explored the relationship between patient pre-treatment object relations (OR) functioning and psychodynamic techniques employed during two early sessions (third and ninth). The sample consisted of 76 outpatients engaged in short-term psychodynamic psychotherapy. Results showed that lower levels of patient pre-treatment OR functioning, particularly in the identity and affective domains, were related to a greater use of psychodynamic-interpersonal techniques in sessions. Patients who had more adaptive management of aggressive impulses were related to a greater use of cognitive-behavioural techniques by therapists. In addition, exploratory analyses between OR functioning and specific psychodynamic-interpersonal and cognitive-behavioural techniques showed that lower OR functioning in terms of affect, self-esteem, identity coherence, social causality, emotional investment in relationships as well as Global OR were significantly related to therapist focus on avoidance of important topics and affective changes during the session. Implications for clinical practice and Q1 future research are discussed.

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.