Measurement of Object Relations - VUIR

Measurement

of Object

Relations

A Review E.

THOMAS

Although

ingly

object

relations

psychotherapeutic phenomena

infancy. intrapsychic and

several

ture

efforts

empirically

remain

interested

processes to assess

construct

reports and

have have

is reviewed,

with involved

of assessment

instruments.

most

reliability widely

general

terested

in developing

ing

object

nonetheless

special

atboth

This

emphasis The

validity

guidelines

author data in an

for

strategies

to individuals

means

tal representations

on

In Freud’s targets

sumon the effort

to in-

measur-

relations.

external

influential

elements

psychology, also

held

of the

the

to be the

least

motivational

sys-

tem, and for a long time psychoanalysts neglected the study of these phenomena. Developmental and personality psychologists, on the other hand, maintained the belief that the genesis of mental representations was of critical importance throughout develand they initiated in this area in the

twentieth posed ternal

century. theories perceptual

Lewin2

intelligence.

These

and

in its failure

Received

May

August

31,

lege and Address

7, 1992;

Plains, Copyright

PRACTICE

accepted Cornell

pro-

representations development

and

did

have

not

and their formula-

for the

June

9,

University

dynamic

1992;

revised

Medical

Col-

Westchester Division, The New York Hospital. reprint requests to Dr. Smith, The New York

Hospital-Westchester White

Murra?

however, psychoanalytic

to account

1992. From

majority of half of the

based upon inand Piaget4

researchers

a clinical perspective, work diverged from tions

the first

of personality experiences,

used the notion of internal in his work on conceptual

OF PSHOTHERAPY

or men-

individuals.

drive-dominated were

left open referring

reality

of significant

of drives

opment, research

JOURNAL

object relaincreasing

as the focus of particular drives question of whether object when

litera-

researchers for

ver the past several decades tions theories have gained

prominence in the disciplines of psychoanalysis, developmental psychology, and psychotherapy research. The concept has humble origins; Freud’s’ initial definition of the object the

in the development

instruments

provide

in their

in studying

validity.

and

used

to study

documented

predictive

()

and

of object relatedness,

levels

the difficulties marizes

are increas-

literature,

Researchers

tempted

theories

in the psychoanalytic

prominent

these

M .D.

SMITH,

Division,

21 Bloomingdale

Road,

NY 10605. © 1993

AND RESEARCH

American

Psychiatric

Press,

Inc.

20

MEASUREMENT

interpersonal

and

unconscious

elements

of

motivational systems. Fairbairn5 and Sullivan6 were among those who subsequently developed psychoanalytic theories emphasizing the role of intrapsychic

object

representations,

so far as to propose ior replace drives tional system. in psychoanalytic there is still

and

they

that object-seeking as the fundamental

created thorough

OF

the opportunity testing of these

hypotheses.

The

psychotherapy over the past

went

behavmotiva-

OBJECT

first

RELATIONS

for a much theoretically

wave

of

represented a major shift thinking, and although controversy surrounding the

findings

from

process and outcome decade has established

tors-quality of pretherapy relationships’t2#{176} and capacity are

strongest predictors object relatedness lie and contribute

studies two fac-

interpersonal to form a ther-

apeutic

This

more based

among

of outcome. are hypothesized to both of these

the

Levels of to underfactors and

question of the hierarchy of motivational systems, psychoanalysts and developmental psychologists have ever since been reformulating theories in an effort to integrate object relations principles and traditional psychoan-

are in fact identified as important selection criteria by the authors of the brief dynamic therapies studied in several of these projects.26’27 Researchers have made preliminary efforts at clariflcation,2t#{176} but for the most

alytic theory. Sandler and Rosenblatt7 were among the first to clearly define internal representations as opposed to external phenom-

part the relationships chic and behavioral be determined. Members

ena, otherslt1O described the internalization processes by which external interactions transformed into stable intrapsychic sentations, and Loewald” reformulated notions such as transference in terms

are reprebasic of in-

ternalized object relationships. Kernberg,’2 who has been one of the leaders in the effort to integrate theoretical notions from ego psychology and the newer object relations school, describes object relations as “the sential units of psychic structure relevant psychoanalytic exploration” (p. 482).

esfor Al-

though there remains considerable variation in the definition of the object relation construct from author to author, psychoanalytic theories of object relations have become increasingly influential, especially from the clinical perspective.’3 Efforts to study object relations empirically

date

back

several

interest proached

in formal that in

schach

data

were

formally document psychotherapy,’4”5 ports

of object

as well,

but

assessment has never clinical application.

decades

apRor-

used

in

change over and a steady relations

the

1940s

to

the course of stream of re-

measurements

was

seen beginning in the 1960s. The recent interest in organized, methodologically sound psychotherapy research studies, however, has

VOLUME

2

#{149} NUMBER

of the

apy Research tal-Westchester several years for studying

these

Borderline

intrapsyremain to

Psychother-

Group of the New York HospiDivision have over the past been developing a methodology the efficacy of psychodynamic

psychotherapy have developed studies ment

between phenomena

for borderline a treatment

patients. manual,3’

of therapist interventions,32 contracts,33 and therapist and

predictive

factors

work is strongly formulations,TM

are under

treatpatient

way. Because

influenced by we are interested

We and

our

Kernberg’s in formally

assessing levels of object relatedness in this group of patients. Our research aims are threefold: 1) to validate an object relationsego psychology theory of developmental psychopathology; 2) to identify those dimensions predict

of object treatment

relations process

psychodynamic

that most strongly and outcome in

psychotherapy

of

with borderline personality to monitor changes in the relations

over

the

course

disorder; quality of

patients and 3) of object

treatment

measure of the efficacy of our treatment dality. In an effort to find an instrument

as a mothat

will allow us to pursue these aims, an extensive review of the literature was undertaken. This article discussions;

1

#{149} WINTER

is a summary of our it is meant to provide

1993

review and the reader

21

SMITH

with an analysis important when sessing ity and

object validity

widely

used

of the factors considering

relations. In addition, reliabildata on several of the most instruments

with emphasis on therapy researchers. the

process

we believe are methods for as-

will

be

reviewed,

their relevance to psychoAlthough we are still in

of developing

an assessment

egy, we believe that the ideas interest to other investigators.

herein

stratwill be of

others from this school WinnicottM has been restricted theoretically accepted is nearly

PRINCIPLES

OBJECT

RELATIONS

same

tion, with

any

scientific

endeavor,

before

at-

tempting a formal assessment it is crucial to have a clear idea as to what is being assessed. The earliest psychoanalytic notions of object relations referred to the tween psychic components

relationships beand real, external

“objects.””35 As Freud’s psychology evolved from a primarily instinctual toward a more motivational focus, clinicians and researchers increasingly emphasized the internal experiences

of self

until

after

lined

above

defined that are

and the

others. major

that

However, theoretical

object

maintain relationships. Kernberg summarizes regarding

the

could

the

and

extreme

are

of object

this

ob-

kind such a

obviates

relations.

theorists

of

British-school thepsychologists such as et al.4’ to develop a

and

lytic

a linking

thinking,

the

only

affective/motivational

placing

less emphasis

tual,

and adaptive aspects.42’43 Although controversies

concerning

ject

relations,

relationship

such

drive energies, influence of development, theoretical verge; for

as their

the role of aggression, environmental factors

remain active,H notions nonetheless our present purposes

the

the At the British

that

structural elements have

dimensions, linking the

motivational,

The

work

JOURNAL

function aggressive of

to and the during

the varied tend to conan object

affective,

tive qualities.47 There is less agreement, ing ing

the most appropriate and organizing

necessary A major ses

however,

Klein

priinand

OF PSHOTHERAPY

PRACTICE

subjecregard-

to describe an object relationship. task for researchers testing hypothe-

generated

identify

and

the-

means for gatherthe information

variables

from that

theoretical

work

can

to quantify

be used

are ideas that are compatible knowledge but not reducible laws. Intervening variables,

energy.

ob-

and 2) representations

the external marily to stinctual

on moti-

aspects and defining representations in terms of their cognitive, percep-

elements of the theoretical MacCorquodale and Meehl process, noting that theoretical

that

by

and social psychologists slightly from psychoana-

school, particularly Melanie Klein,37 who defined object relations as unconscious fantasies, with a genesis relatively independent of environment, manage innate

means

can be known. Kernberg relation unit as consisting an object-representa-

state. Developmental continue to diverge vational primarily

are

subordiwhile at

specific matic

con-

of the

definition

for any theory

they

itself Kern-

current

toward literature,

other

and

and is so many

relation will be defined as a stable intrapsychic structure consisting of both 1) self-representations and object-representations with

though there is a tendency of thinking in the clinical need

be

at one extreme any can be described in including conflicts, phenomena. Al-

specificity

time

it

phenomena to form and

definition

ject relations construct; psychoanalytic principle object relations terms, defenses, and transference

lacks

not out-

relations

as purely intrapsychic the basis for the capacity

troversies

it was shifts

principles to validate.

theory in which object relations are nate to sexual and aggressive drives which these drives defines an object of a self-representation,

IN

ASSESSMENT

As

psychoanalytic impossible

bergl2ss39 has integrated ory with that of ego Jacobson4#{176} and Mahler

the GENERAL

such as Fairbairn5 influential, but that it excludes

AND RESEARCH

is to

formulation. describe this constructs with general to empirical on the other

22

MEASUREMENT

and sufficient These variables

purpose

of empirically

knowledge that refute elements tion.

If there

for the truth exist only establishing

is consensus

of the for the a body

by inference will of the theoretical that

in both

of

support or formula-

the

ports ies.

variables level

chosen accurately reflect the theoretical notions, less inference will be required, and judgments regarding the validity of the theory can be made with greater confidence. Problems can arise, however, in that variables that that

best reflect theory are often concepts are too abstract for empirical use. This dilemma is very much evident in object relations research. Table 1 lists many of the variables tify structural, mensions of

(e.g., differentiation, easy to imagine

to

be

either

too

quantification (e.g., crete for interpretation

abstract

mutuality) in the

for

TABLE

commonly

Level

1.

Variables

Conscious/self-report (psychotherapy

testing research)

research)

Interpersonal/observational (developmental psychology)

to measure

object Self-

of Observation Focus)

(Theoretical

Unconscious/projective (psychoanalytic

used

Inasmuch

as object refer

relations

terpersonal ture can

behavior, be derived

to conscious phenomena

A review

of the

for

in the

by the data. most

revealing all three

literature

reveals

of any dictates

particular the choice but

scriptions of relationships and nomena is in part a reflection improved interrater reliability methodologies become more

relations

and Object-Representations Structure

Motivational

Differentiation Articulation Integration Organization Individuation

Relatedness Motivation Mutuality Social causality Investment

Image Egocentricity Role behavior Self.esteem

Stability Autonomy Coherence

Object constancy Hostility Empathy Resentment Alienation

-

-

NUMBER

#{149}

that reof also

subjective pheof the need for as research sophisticated.

Complexity Richness Maturity Psychosexual Affect tone

2

in-

choice of methodoldata. Psychoanalytic almost exclusively on assessing object rela-

Content

VOLUME

gen-

their naof these

quantification

influences the gathering the have relied test data for

restud-

and unconscious that influence

data from

focus not only

used

individual between

tions. Psychotherapy researchers, on the other hand, have increasingly relied upon self-report and interview data. The increased emphasis on conscious de-

reliable

relations (e.g., affiliation). of variables itself indicates

from

groups the variables used in collecting

eral sense intrapsychic

strongly ogy for researchers projective

or too concontext of any

theory of object The sheer number

RELATIONS

comparisons

Table 1 also of observation

variables

hostila contin-

data

making

the theoretical search group

uum from sickness to health that is both consistent with most theoretical orientations and quantifiable. Other variables, however, seem

interpreting and

spheres.

that have been used to quancontent, and motivational diobject relations. For some of

these variables ity) it is relatively

OBJECT

that the process of operationalizing concepts from object relations theory is one of the most complicated tasks for researchers and probably accounts for most of the difficulty

hand, are by definition wholly reducible to empirical laws, the validity of which is both necessary concept.

OF

themes

1

#{149} WINTER

Aspects

Affiliation Interdependence Investment Attachment Role behavior Social competence

1993

23

SMITH

Reliability

of assessment

but at the expense relations theories

has

been

improved,

only

of validity-most object acknowledge unconscious

those

instruments

that

of object relations matic dimensions,

allow

for

along structural as defmed above.

ratings and theTable 2

elements, which are not as well captured using this method of data collection. Finally, developmental and behavioral psychologists have used a strictly observa-

summarizes the crucial characteristics these instruments. For each instrument, review will focus on the features outlined

tional

structs, operationalization processes, data collection strategies, reliability, and validity. Formal studies of internalized represen-

approach

to document

the

interpersonal

behaviors in a wide variety of settings, including psychotherapy sessions. These methodological approaches are the most sophisticated reliability

and ratings.

have achieved the These researchers,

ever, maintain a strictly empirical largely eschewing preconceived systems. study,

Although interpersonal

function relevant

from intrapsychic scriptive terminology havioral sciences tween relations

general

theoretical

the

the these

relationships reports

be-

and

object

theories.

These within

from

and is therefore exclusion of data

sources and the use of defrom the social and belimit the usefulness of

regarding data

approach, theoretical

the phenomenon they behavior, is clearly a

of object relations to this review, the

inferences

highest how-

principles-the notions

complexities

of object

associated

with

table:

tations object Pruitt files,

and

son’s

Object

subjects’ human

responses figures with

succeeded sponses passivity,

namic

human

versus

were

felt

to reflect

jective excellent acteristic relations,

ature object

focusing relations.

viewed

processes

there

on measurement This literature

in a historical

are

still

is a considerable

format,

in

variables training

described stimulus

and

how the of a pro-

such as the Rorschach was an means of eliciting responses charof the subject’s dominant object and reported another validation

wherein

human

responses

from

Project53

were

These

rated

ratings

for global

correlated

Rorin the Relevel

with

of

other

variables, including quality of interrelationships, anxiety tolerance, ego and

level

of psychosexual

develop-

the

At the same time, a number of theorists and researchers were becoming interested in the role of early memories as reflections of intrapsychic phenomena. Renewed interest

liter-

the lines

OF PStHOTHERAPY

clinical

ment.

of thinking from their development in the 1950s to the present. The review will include

JOURNAL

with to vocational

that

relatedness

dy-

strategies for will be retracing

content)

schach protocols in a group of subjects Menninger Foundation’s Psychotherapy

patient personal assessing

correlated

test

function.

TO

major methodologstandards, but they

of object

psychotherapy. Mayman52 relatively unstructured

study

cards depicting features. These

nonhuman levels

relations,

OBJECT

intrapsychic

of infancy,

to blank equivocal

as response

translating

Philipto study

in identifying qualities of reto projective tests (e.g., degree of persistence, participation, amount

strength,

stage

Hahn5#{176} used

Technique5’

that

RELATIONS

for

and

Relations

such

USED

methodologies

Rayner

preliminary studies have ical weaknesses by today’s

of

con-

first appeared about a decade after relations theories became popular. and Spilka49 studied Rorschach pro-

search

Although

theoretical

and

egies.

MEASURE

underlying

variability

hypothetical constructs into empirical variables, and the influence of the method of data collection-are important considerations when analyzing particular object relations measurement strategies. Keeping them in mind, we can now review the specific strat-

INSTRUMENTS

its

of this in

in the Adlerian combined with theories

PRACTICE

and

notion interest

led to efforts

AND RESEARCH

of “styles of life”556 in object relations to study

early

mem-

24

MEASUREMENT

OF

OBJECT

RELATIONS

ones as manifestations of character Mayman57 and others59’6#{176}have

structure. reviewed

in

of object relations and capacity to benefit from intensive psychotherapy. The correla-

detail

for

as-

tions

the

sumption ities for

theoretical

that object

rationale

the

early memories express capacrelatedness; what is of interest

for this review used by Mayman

is that this methodology and his group at the

was Univer-

of Michigan when they developed the earliest structured assessment instruments. Ryan28’6’ studied hundreds of early memory profiles and developed the Ryan Object Relasity

tions

Scale,

which

contains

chor points organized hierarchy from psychotic

20 descriptive on

a to

an-

four-level borderline-

were

modest,

of symptomatology between clinical

and

controlling

revealed ratings and

schach or early memories. functioning” patients did ings from dream reports use

psychotherapy.

for

level

no relationship ratings from Ror-

Only in “higher object relations ratpredict capacity to

Urist47’65

and

Unist

and

Schill used the Mutuality of Autonomy in much the same way, rating Rorschach files,

autobiographical

reports,

cords, and therapist with a broad range

Scale pro-

medical

impressions of diagnoses.

re-

of patients “Mutuality

depressive, neurotic, and normal (see Table 2). Interrater reliability was established, and the instrument was used in two studies. In the

of autonomy” is defined by Urist as “the capacity to attribute to others an autonomous, inherent identity and to cathect them in their

first, increases pretreatment

own right.” encompasses

average mented

1-year hospitalization were in a group of schizophrenic

tients.6’ other

in object relations ratings from to 6-month follow-up after an

These

ratings

outcome

ond study psychotherapy treatment amount

did

variables;

of neurotic in an ratings of variance

not

docupa-

correlate

however,

patients outpatient

with in a sec-

undergoing setting, pre-

accounted for in patients’

the largest capacity to

establish a therapeutic alliance.ss In the years following, the same group developed two other instruments, both incorporating notions from a wide range of psychoanalytic cluding Kohut,62

object

Fairbairn,5 Klein and Winnicott.M

man63

developed

Scale for including empathy study

relations

the

Object

Dreams, which differentiation

theorists

Krohn

Kernberg,39 and May-

Representation assessed variables and capacity for

(no

done) they found 0.2-0.6 range for from Rorschach and dream reports,

diagnostic

evaluations

were

intercorrelations in the ratings of object relations profiles, early memories, which they interpret as

supporting the notion of level of object edness as a stable variable. In this and these

study,TM

ratings

with

In a psy-

they

went

treating

on

to

relata sub-

correlate

clinicians’

VOLUME

ratings

2

NUMBER

#{149}

definition of object

that re-

lations and does not lend itself well to empirical use. There were problems establishing interrater reliability with the instrument, and only

percentage

agreement

ported in these studies. by Harder et al.67 sought

data

tions

between

ferent earlier

mutuality just

re-

study reliabil-

Nonetheless, strong correla-

ratings

data sources, work.63’

were

(A subsequent to improve

ity, with moderate success.) these studies documented as

from in

the

the

dif-

group’s

Overall, this preliminary work from the University of Michigan group established that level of object relatedness was a fairly stable concept

that

could

ety of sources.

from manifest dream reports. of 24 patients receiving outpatient

chotherapy

sequent

in-

This is a global many dimensions

classical

be measured

These

researchers

notions

of

with

object

combined

from

a vari-

drew

upon

psychoanalytic relations

theory theory,

and

they measured dimensions emphasizing matic as opposed to structural elements object

relations.

The

dimensions

defined, and the studies cally. They were among

were

theof

loosely

suffer methodologithe first, however,

develop structured assessment scales, some which are still used today (see below). Around the same time that the University of Michigan group was developing its scales, a group headed by Blatt at Yale was developing

1

assessment

WINTER

#{149}

1993

strategies

combining

notions

to of

25

SMITH

from

psychoanalytic

developmental and Werner.TM representations mata

of

reality; focuses

ego

psychology

psychology Within are

and

theories

their framework, defined as mental

significant

objects

their Concept on structural

the

of Piaget4 object sche-

encountered

in

of the Object Scale42’ elements and assesses

non, thors

articulation, concluded

hibit

more

expense curately

and integration. The that mentally ill subjects

mature

object

of reality perceived

relations

of differentiation, of representations.

articulation, and Rorschach

accurately

profiles

provide

source,

seen in the mentally ill group reflect uncontrolled factors fluency. There are other

the

data

with

the

presence or absence of specific phenomena dictating the rating level. The differentiation variable assesses the degree of human versus quasi-human detail, whereas the articulation dimension notes the presence ceptual and functional elements resentation

described.

variable between

assesses the representations,

of passivity/activity, malevolence within In the original

of specific for each

The

perrep-

integration

degree of interaction noting the amount motivation, fusion, each interaction. report by Blatt et

three separate studies lidity for the Concept the first, a longitudinal adolescents and young

provided construct vaof the Object Scale. In study of 37 normal adults, changes in the

expected directions were seen in all dimensions as the subjects were rated at intervals from the ages of 11 or 12 to 30. The second level

an of object

gree

of

study

was

effort to relations

determine correlated

symptomatology

psychiatric

inpatients.

in The

whether with de-

a group

patients

of were

divided according to degree of thought der, and the only significant differences noted on inaccurately perceived human schach responses, severe thought developmental mension.

Similar

where disorders levels on findings

third study, which compared patient groups previously curately perceived responses distinguish jects tended gration perceived onstrated

and

48 sub-

disorwere Ron-

patients with more scored at higher the articulation diwere

noted

in the

the normal and described. On acit was difficult to

the groups, although normal subto have higher measures of intedifferentiation. responses, the more

mature

On patient levels

JOURNAL

Concept

inaccurately group demof clifferentia-

OF PSItHOTHERAPY

of the

the

perceived

Object

of object relations. Further studies ner

al.42

responses;

inaccurately

had to

higher

responses

mayjustas likely such as verbal methodological

weaknesses, including the lack of formal agnostic assessments and the reporting only percentage agreement as a measure interrater reliability. Despite these weaknesses, this study documented initial validity the

and

perceived on

the inacOn

in this study as opposed

degrees integration

scores

at

testing (i.e., only on Rorschach responses).

the other hand, all subjects lower ratings on inaccurately

auex-

and

Ritzler

et al.73 used the Concept in efforts to differentiate

of

as a measure

by Hymowitz

St Peter,7’

borderline, marize,

Scale

diof of

et al.,7#{176} Ler-

et al.,72 and

Stuart

of the Object Scale schizophrenic,

and depressed patients. To sumschizophrenic patients were distin-

guishable from neurotic patients for developmental

borderline, depressed, on the basis of lower level on all dimensions

and scores for

both inaccurately and accurately perceived responses,7”72 and borderline personality disorder (BPD) patients were distinguishable from normal subjects and patients with major depression tion

on

and

the study differences

tion.74 The significantly ments ability.

basis

using blind

motiva-

in these with

structured raters

In

et al.7#{176} no significant between psychotic

patients grouped levels of personality methodology improved,

and

of increased

of representations.73

by Hymowitz were noted

and borderline to Kernberg’s

group73

the

malevolence

according organizastudies was the Stuart

diagnostic with

instru-

established

reli-

Attempts to document construct validity for the Concept of the Object Scale continued as Spear and colleagues777 divided BPD patients into those with obsessive/paranoid versus

PRACTICE

hysterical/impulsive

AND RESEARCH

features

and

com-

26

MEASUREMENT

pared both

them with the Concept

scales

measuring

structural scale

for

TABLE

2.

schizophrenic of the Object thematic

aspects

of object

dreams,

and

Instnunents

for

as

on and

opposed

to

relations Unst’s

measuring

Instrument

(Krohn’s Mutuality object

of

Autonomy matic and

borderline

patients

(borderline

higher

Scale

Object Representation (Krohn & Mayman63)

Scale

MutuaIi (Urist

of Autonomy

for

Dreams

Scale

)

Concept (Blatt

of the Object et al.42)

Relations

(Diamond

Scale

Inventory

RELATIONS

from

the

levels),

scored only

the

relations Variable(s)

Psychoanalytic, relations

object

Psychoanalytic, object relations

drive

Psychoanalytic, relations

object

1. 2. 3.

and

Psychoanalytic object

Emotional Integrity Quality self/others

Capacity fusion,

quality of representations of representations of interaction between

for empathy, identification, and differentiation

Mutuality

of autonomy

Differentiation Articulation Motivation to action Integration of object Content of action Nature of interaction

(Stern82),

relations

(Mahler41)

and

action

Separation/individuation Intersubjectivity

Human Relations Scale (Gottschalk et al.85)

Psychoanalytic, oriented

drive-

Psychosexual

Ego

Psychoanalytic, psychology

ego

1. 2. 3. 4.

Relatedness to others Primitivity/maturity Degree of differentiation Maintenance of object

Psychoanalytic, relations

object

I. 2. 3. 4.

Alienation Insecure attachment Egocentricity Social incompetence

1. 2. 3. 4.

Complexity of representation Affect tone Capacity for emotional investment Understanding of social causality

1. 2.

Coherence Stability

1. 2. 3. 4.

Behaviors Affect regulation Self-esteem regulation Historical antecedents

Function Assessment-Object Relations Scale (Bellak et al.87)

Bell Object RelationsTesting Inventory (Bell et al.90)

Measure (Westen

of Object et al.94)

Developmental (Horowitz

Quality (Azim

Reality

Relations

Level

Psychoanalytic, developmental psychology

of Self-Concept

social

Psychodynamic

101)

of Obect Relations et al. 02)

Scale

Core Conflictual Relationship Theme Method (Luborsky & Crits-Christoph’#{176}7)

Psychoanalytic, relations

Psychoanalytic, developmental

VOLUME

2

NUMBER

#{149}

object

psychology

1

WINTER

#{149}

level

of development

Transference: 1. Wishes/intentions 2. Response from other 3. Response of self

1993

thediffer-

schizophrenic

patients

developmental

Ego and developmental psychology

et al.83)

OBJECT

scale). Whereas both the structural instruments

entiated

Construct

Ryan Object Relations (Ryan & Bell61)

Object

patients Scale

OF

constancy

at the-

27

SMITH

matic instruments subtypes, with the scoring ability

higher, was good

ficients

of

differentiated hysterical/impulsive

the

BPD group

as predicted. Interrater for these studies (alpha

0.82-0.96),

which

suffer

relicoef-

Reliability

20-point made

Intraclass interrater

r

Required

consensus

8-point early

7-point

scale for memories,

scale

rating dreams, or Rorschachs

for

rating

Rorschachs

Only

a lack of formal work is especially

instrument subgroups

again

Methodology scale, 4 levels. Ratings from early memories

from This

was able of patients

tic category

(BPD),

10-point anchored scale for descriptions of significant

Good

Verbal content samples

analysis

Semistructured anchored

scales

90-item

report

self

rating others

of speech

interview,

7-point

=

0.86 for reliability

Strong pretreatment readiness behavior

ratings

reported

to good

r

Satisfactory,

1. 2. 3.

Consistent Predicted Predicted patients

=

0.85

replicated

Intraclass Brown

5-point scale pretreatment

scored after evaluation

Intraclass

5-point scale unstructured

rated following interview

Kappa = 0.52, r= 0.50

Relationship transcripts

used

from to identify

Consistent projective

training

findings

r= 0.74

Kappa

JOURNAL

OF PSHOTHERAPY

=

groups

Differentiated

aspects; correlated degree of

of treatment (N= 4) sample

diagnostic

1.

Predicts

2. 3.

Replication in 2nd As content measure, more pathological patients

1. 2.

Predicts Changes cohort

Predicted term

for

Extensive measure

PRACTICE

in

ratings using different measures; differentiated

seen of

as

be used

groups

diagnosis

diagnosis as expected

study borderline patients than schizophrenic

over

Predicted capacity to benefit exploratory psychotherapy study

intraclass

0.59-0.70 categories

of alliance-

Construct validity never established Content analysis methodology can with other scales

and Spearmanr= 0.71 -0.96

session themes

standard

of any

across measures symptom ratings capacity to use therapy with low symptom ratings

Emphasizes structural with diagnosis and psychopathology

with

5-point scales for rating Thematic Apperception Test, Rorschach, early memories

episodes

an

between diagnos-

feature

predictor

Changes over course expected in small borderline patients

Interrater

Have

to discriminate within a broad a necessary

diagnostic Moderate

assessment. in that

Validity/Remarks

% agreement

Rorschach profiles are rated, distinguishing between accurately and inaccurately perceived responses

diagnostic significant

process psychotherapy

and

outcome

time

in single

from in single

in short-

use as process and outcome in Penn Psychotherapy Project

AND RESEARCH

28

MEASUREMENT

instrument

to

therapy

be

considered

for

process/outcome

study.

a psychoThey

procedure,

were

also the first to make the argument that object relations assessment instruments should be multidimensional, noting the differences between ratings of thematic and structural

OF

the

(OR!),

in which

nificant

others

tured

Object are

from

these

elicited

descriptions.

The

Kavanagh78 of the 42 Menninger

test responses, which are cluded in standard clinical

search tively and

Project,53 and reviewed medical schizophrenic

Blatt et al! retrospecrecords of borderline patients

tensive psychodynamic of long-term (average treatment. In who completed

the

tuality Object

as part inpatient

study78 patients psychoanalysis

on all dimensions of in the Blatt et al. study79 was noted on the Mu-

responses.

retrospective mensions in efficacy In

an

thematic

effort

more

object

described Theme

level”

the Scale,

theories

fully

relations,

between

One

rater

reliability.

The

in ways

concepts

structural collective

upon em-

concept separation-

of

scale described by scale is part of a larger

2

solid

grounding

a

and

ease

the

in

of object of develof data

it appealing

major

have

col-

to a great

Yale

group

has

to that

of the

NUMBER

#{149}

1

This as the

findings, validity

to formally Although generalization

levels

of

methodological from many

assess

of

they have provided initial confor the notion of levels of object reviewing

mention

#{149} WINTER

psy-

elements of object relations. body of work can be regarded

the use of assessment to

largely

upon and

effort

have assess

been

relied thematic

initial

relatedness. Before

always

and they test data to

these struct

VOLUME

to

early University of Michigan group, as evidenced in the number of studies that use instruments from both groups. Their theo-

This scale was further elaboall of Mahler’s phases of

individuation-relatedness Diamond et al.83 This

OR!

the

object rated

as well as Stern’s with a final

the

undergoing as part of

complementary

object relations. weaknesses limit

development intersubjectivity,82

ORI’s

phenomena,

phasized the process of separation/individuation as crucial to the formation of mature relations. to include

used

evolved

1986

and

less frequently inevaluation proto-

study

lection should make number of researchers. The work from

choanalytic, projective

of development

mem-

widely accepted theoretical notions relations, coverage of a broad range

retical

in

early

using

time-consuming proor other projective

levels of function. Although the number of subjects in these studies is too small for generalization, the results are encouraging, and the authors were able to achieve good inter-

depression

drew

published

(e.g., a data

long-term hospitalization,83 and in a second study”’ ratings of the quality of object representations showed some correlations with

instrument and

for

for

people as

for

Separation-Individwhich

cols.

opmental

developed a broader reported a preliminary

representations,8#{176}

Coonerty8’ Mahler’s4’

of

relationship

parental

uncontrolled promise that dican be assessed

account

a “conceptual

the

uation

to

elements gradually They

using

to assess

These

studies hold of object relations studies.

Yale group methodology.

and

of

in-

of Autonomy Scale and Concept of the ratings from inaccurately perceived

Rorschach

study

psychotherapy 18 months)

to that

ories and eliminates the cess of eliciting Rorschach

be rated

rationale

document changes in 4 patients psychodynamic psychotherapy

undergoing

Kavanagh a course

showed improvement both scales, whereas modest improvement

on 33 the Re-

assessing can

of important self, therapist)

is similar

of sig-

a semistruc-

variables

using descriptions mother, father,

studied Rorschach profiles patients who completed Foundation’s Psychotherapy

in

representations

aspects. In two other studies the Concept of the Object Scale was used with the Mutuality of Autonomy Scale to measure change in object relatedness over the course of psychotherapy.

source

Inventory

descriptions

Several

of object

RELATIONS

Relations

subjects’

interview.

quality

OBJECT

briefly

1993

recent strategies, a few

efforts

to extend

it is necessary other

reports.

29

SMITH

Gottschalk et al.85 developed the Human Relations Scale for use in one of the earliest psychotherapy retical orientation lytic,

outcome was

emphasizing

intrapsychic

the

Their theopsychoana-

relationship

phenomena

fects) to mensions levels of veloped content tween

studies. orthodox

of

(particularly

af-

external objects. They identified diof object relatedness based upon psychosexual development and dea method for analyzing the verbal of speech samples. Reliability be-

two

could not pretreatment

raters

was

established,

but

they

establish validity. In two studies,35”t’ morbidity was found to account

Assessment sures object 7-point

theory base, Ego Function

(EFA) scales, one of which relations. Ratings are made

anchored

scales

following

borderline,

dered, neurotic, ous studies.TM89 to assess test data

eating

and normal Like Bellak,

tionships with significant oped the Bell Object Testing report for

human

relatedness.”9#{176} are

language: egocentricity, two

described alienation, and

studies90’9’

the

tive disorder high-functioning consistently

higher

(more

linked

to that

of mature

object

JOURNAL

on

raise

as a measure

psychodynamic

processes

data

and

review

psychoanalytic

object

theory.

that

aimed

to

ity for emotional investment and moral standards, and social

along

causality.

and

instrument

of representations,

four

Each

data.

PRACTICE

This

AND RESEARCH

group

social

psy-

measures com-

tone,

capac-

in relationships understanding

dimension

of

is repre-

with anchored developmental made from Ror-

schach profiles, early memories, Apperception Test (TAT) reports, view

to inte-

dimensions: affect

sented by a 5-point continuum descriptions defining specific lines, and ratings have been

rela-

and empirihis group’s notions from

relations

Their

relations

than

associaborder-

on object

grate a wide range of theoretical cal work, Westen43 described approach, which incorporates

plexity

supporting the of BPD is closely

OF PS’StHOTI{ERAPY

of new

object

and scored

relations.9’

and the increasing object relations with

In

subaffec-

pathological)

all other comparison groups, notion that the development

methodology its validity

of unconscious as well as conscious intrapsychic phenomena. By the late 1980s two major forces were influencing object relations research: an emphasis on improved methodologic standards

chology

shown

and normal BPD patients

self-report regarding

diminishing pool tions measurement.

it

insecure attachment, social incompetence.

patients, adults.

and

In an extensive

dimensions

was

a

the EFA of time

tors are evident in the work of the University of Michigan group, which is now headed by Westen and has produced the majority of a

an interpersonal

BORRTI

studies. from

for training and data collection. There are also issues regarding theoretical orientation; there is diminished interest in the ego psychology approach of Gottschalk and Bellak given the rise in popularity of object relations theory, and the BORRTI’s interpersonal lan-

devel-

differentiate a wide variety of diagnostic types, including schizophrenia, BPD,

the original Scale suffers

line psychopathology, due largely to the writings of theorists such as Kernberg,M Masterson,92 and Adler.93 Both of these fac-

from projective reports of rela-

The

using

outside of Relations

semi-

Inventory (BORRTI), a 90-item seW that quantifies the subject’s “capacity

assesses

Bell interbeen

psychotherapy, tion of distorted

disor-

others. They Relations-Reality

and

lack of demonstrated validity, and profiles require an extensive amount

in research

subjects in variBell et al. wished

object relations not but from subjects’

Bellak,

have all reported instruments have

meaalong

structured interviews, and EFA profiles (comprising 12 ego functions) have differentiated schizophrenic,

Gottschalk,

rarely Human

questions

brief dynamic psychotherapy, with pretreatment ratings of object relations failing to predict outcome. Using an ego psychology et al.87 developed the

used The

guage

for the majority of variance in posttreatment morbidity in a group of patients undergoing

Bellak

Although

and their co-workers esting findings, their

has

Thematic and intermaintained

30

MEASUREMENT

methodologic

standards

ers, using structured blind independent liability, and suitable studies. In

the

higher

than

any oth-

diagnostic assessments, raters with established recontrol groups in most

Westen

group’s

first

two

re-

ported

history

lent

object

effort

control

bridge nomena

subjects

in both BPD

developmental emotional

adolescent

and

adult

at

lower

social causality demonstrated

and wide

patients

levels investment,

for

scored

variability in ratings of complexity of representations, and had consistently higher ratings of malevolent affect tone in comparison with all other groups. In a second ies96’97 measures of object relations pared normal

across age groups control populations.

tients when

with only the to distinguish were obtained

age children descriptions graders

scored

higher higher except

construct

cused lations

on

variables.

than than affect

validity

2nd-graders, 9th-graders, tone, providing

for their

turbed

adolescent significant dimensions

(particularly traumatic ual abuse), as neglect, al.90 TAT tients finding

used data

on

this

females

fo-

of their

scale

and

and normal significant

parental sex-

2

been

of object the

used

to

They attempt

are to

intrapsychic pheevents as hypothe-

over

the

past

of object

in

relations

subject. in their

any

several

relations

has

psychotherapy

pro-

cess/outcome studies, and, as his review43 indicates, he is largely interested in studying assumptive frameworks put forth in the theoretical literature. He has drawn a number of conclusions from ing the development

the

empirical of mature

tions, First,

are that

relevant to this review. the notion of object

two of which he believes encompasses

can vary

affect other

and

data regardobject rela-

multiple

should

dimensions

be assessed

NUMBER

#{149}

largely reports

indepen-

derived of how

tone do not vary in the dimensions, especially

same in

patients. Their affect tone scale continuum from benevolence lence and does not assess other

or

all

subjects, again between re-

VOLUME

not

al.98

reports instead of study of BPD inpa-

control correlations

sized by theorists decades. Westen’s measure

aspects relations

and preoedipal risk factors such separations, or adoption. Nigg et early memory in a subsequent

levels

the gap between and historical

dis-

between

maternal) psychopathology, childhood experiences (e.g.,

studies

conclusions are group’s consistent

object rehistory et

malevo-

all fur-

has

Westen

and These

and

of 36 psychiatrically correlations

to compare

that

rela-

group

abuse

representations.

events as recalled by nevertheless interesting

relations

as

object

of sexual

RELATIONS

dently. Second, a continuum of development of object relations does not necessarily parallel a continuum of pathology. Both of these

instrument

the relationship between ratings and developmental In a group

pa-

using TAT and episodes. Fifth-

a measure of developmental tions.97 The latest work from

four

BPD and BPD pa-

affect tone dimension the groups.96 Similar when normal school-

were rated of interpersonal

12th-graders dimensions

found

both Adult

scored higher on 3 of the 4 dimensions compared with adolescent BPD

tients, failing findings

ther

in

set of studwere com-

OBJECT

have methodological weaknesses in that the data on childhood experiences were retrospective, and in the Nigg et al. study90 the use of early memory data must confound any

ports,94’95 construct validity was obtained by using the instrument to differentiate BPD from affective disorder patients and normal populations.

OF

of affect development such as intensity,

integration.

It may

developmental comprehensively

his of

ways as the borderline is a simple to malevotheoretical

within object appropriateness, be

line of object incorporates

of theoretical into a single attempted relatedness

yet

from ratings

possible relations a wide

that

a

that range

notions may be operationalized scale instrument, as has been with the separation-individuationscale of Diamond et al.83

The final body of work to be extensively reviewed comes from the psychotherapy research literature of the past decade. Early psychotherapy

1

WINTER

#{149}

research

1993

projects

such

as

31

SMITH

those of the Menninger Boston Psychoanalytic

Foundation53 Society and

and the Institute’90

made reference to object relations but not devise methods of formal assessment. noted

above,

more

much greater methodologic this, and process terms,

recent

also and

because outcome

there

have

the influence relatedness

have

on Perhaps

been

few

efforts levels Once

these Ryan

developing witz et al. relationships

and

Piper between

and self

following reliability relations

a pretherapy was established, were obtained

and

outcome

hort

undergoing

In subsequent attention toward

personality and this

and interpersonal is not mentioned

tions

group led to focus

as predictors

apy and Relations orientation

levels in

of a co-

however, of object in psychother-

a Quality group’s

ego

has rela-

of Object theoretical

psychology

and

ob-

term

modeled DSM-III

justment, and vided according

wait-listed relations month

JOURNAL

OF PS’iUHOTHERAPY

are

reflecting

overall single arithmetical ratings studies

score proce-

predictof short-

therapy.’#{176}3”tu conducted

a

psychotherapy

Malan.26 Outpatients of primarily affective,

with ad-

personality disorders were to quality of pretherapy

patients with low quality doing the worst at outcome follow-up;’05

2) quality

tions was a stronger predictor alliance than interpersonal

di-

subseversus man-

3)

in patients

rated

of object and 5-

of object

rela-

of therapeutic functioning;3#{176} high

on

quality

of

object relations, an increased frequency of transference interpretations was associated with poor therapeutic alliance and outcome.1#{176}6This last finding is difficult pret, but it represents the group’s

to interefforts to

extend the use of the instrument in studies of the interactions of dynamic elements of psychotherapy.

Overall,

ogy is good, only moderate

although interrater

chotherapy

Two

levels

ual was used with adherence ratings, and outcome was assessed multidimensionally. A number of findings have been reported: 1) patients with high quality of object relations ratings and immediate therapy did best, with

regulation,

antecedents.

rela-

points

object relations (high versus low), with quent randomization into therapy wait-listed control groups. A treatment

instrument. continue

historical

to the

of short-term

after diagnoses

a tri-

of object 100

and group subsequently

study

represent

and primitive strength of the to account for

level

with an a simple

proa single

of mature,

contexts;

differentially

individual This group

ject relations principles, encompassing dimensions of behavior, affect and self-esteem and

points

dure. In their initial reports, ed outcome in naturalistic

and

relationships, again.

by Piper, on levels

has developed Scale.’#{176}2This

dy-

stress-related work Horowitz assessments of

of outcome

combines

by time-limited

for

syndromes. turned his

The continued

experiences were made

functioning)

psychotherapy

scale

co-

evaluation, interrater and significant corbetween these rat-

and

of adults

namic

psychotherapy. Developmental to rate the

(measured

symptomatology

various

controlled

Horo-

anchor

along

descriptions

in a subject’s

within

this variability, derived through

out-

interviews

for rating

controlling, searching, provided. A major is the rater’s ability

of object the rela-

and

stability of subjects’ and others. Ratings

angular, prototypes instrument

The with

assigned

et al.3#{176} found significant quality of object rela-

tions and outcome in brief Horowitz et al. used their Level of Self-Concept Scale10’

scale.

continuum

1-hour

source

to assess

between capacity for

alliance,

5-point

tions

factors and object relations. and Cicchetti28 study described

a therapeutic

unstructured data

the

fluctuation

however, researchers on the hypothesized link

above documented a correlation level of object relations and the

ings

of

to describe behavioral

between pretherapy interpersonal therapeutic alliance, and

come were established, focused their efforts

herence of their

placed

improved because

of the wish in more

of the patients’ in psychotherapy.

tionships functioning,

between The

efforts

emphasis standards.

did As

separate vide

PRACTICE

Further to provide process

AND

RESEARCH

the

group’s

they

use of the interesting and

methodol-

have established reliability with the

outcome.

scale data

should on psy-

32

MEASUREMENT

The searcher object

other

major

who relations

sky, who, with Psychotherapy oped Theme

patterns major

as

part

relationships. the instrument

of

a psychotherapy

project; transcripts the data sources

of therapy from which

are made of subjects’ ward others as well from

to object to capture

others

thematic internalized

and

Of was resessions ratings

wishes/intentions toas expected responses

self.

The

instrument

rates

as opposed to structural aspects of relationships and tends to em-

phasize real interactions sied object relations. lished,

it

Interrater and

as opposed

to fanta-

reliability has been estabCCRT method has been used

the

extensively in the Penn Project,’#{176}7which studied nonpsychotic outpatients (mostly affective, anxiety, and adjustment disorder patients) formulations

in

dynamic psychotherapy. were used to reliably

pervasiveness themes,

of accuracy

specific

CCRT calculate

transference

of interpretations,

and

level

of self-understanding, all found to be good predictors of outcome. Procedures for collecting data for this method are time-consuming, and a significant amount of training is required for judges to be able to reliably identify relationship episodes, wishes, and responses of other and self. Also, the group is only beginning to use the instrument in a wider

variety

BPD.

Our

borderline inability from

those

of diagnostic group’s

preliminary

patients to distinguish of self

groups,

were given

efforts

hampered responses the

including

often

of

of the

CCRT

first

method

truly

rarely

seen

such

outside

the

as defenses

be viewed methods

pected future

that the research

tal and object

influence

and

of

CCRT efforts

in

manifestations

of

this

review

to mention briefly the on personality factors,

styles, research

and

object itiated ioral,

relations theories by developmental, ethological, and

in

relationship these areas

Sophisticated evolved and

It is ex-

method will be used to clarify developmen-

psychopathological

relations. Before completing

sary ture

of processes

transference.

it is neces-

extensive literainterpersonal

patterns. began

Empirical long before

were

formulated, incognitive, behavsocial psychologists.

assessment been increasingly

strategies used

in

have psy-

chotherapy research projects. Examples of the more recently developed instruments include Benjamin’s Structural Analysis of Social Behavior’08 as well as methods for assessing role-relationship models’90 and cyclic ma!adaptive patterns.”0 tions theories were explain

behaviors,

mention relations

and

that their phenomena,

garding object from this body

This

of assessing

many

are These

structural object

has

the relationships relations and factors.

1

WINTER

#{149}

1993

relations,

to clarify

object re-

observable dynamic pro-

focused and

writers

difficult to make instruments are

they emphasize expense of

review

it will be of interest

of these

methods capture interpretations

relations of data.

less specific, and behaviors at the cesses.

Although object reladerived from efforts to

to be relatively independent tors; with further improvement

#{149} NUMBER

group issues

analyzing intrapsychic processes. The focus of the instrument is on transference phenomena, but object relations principles blend into most other psychoanalytic principles and are

by an others

2

can

empirical

of intrapsychic

extensive

RELATIONS

data from the in clarifying

to rate

occurrence of aggressively influenced wishes and primitive defenses such as splitting and projection (Michael Selzer, personal commu-

VOLUME

OBJECT

The newer very helpful

be

as these. Overall, the

as one

Relationship rating transfer-

as opposed in an effort

nication). should such

Penn devel-

underlyand

used in conducting significance is that

search provide

assess Lubor-

orientation is psychoanalytic,

transference phenomena

developed

re-

formally is Lester

Conflictual method for

The theoretical methodology

emphasizes relations

to

his colleagues in the Research Project, has

the Core (CCRT)

ence.’07 ing this

psychotherapy

has begun phenomena

OF

on

thematic which

methods aspects are felt

of external facof technique in greater

between measures interpersonal/personality

detail of object

33

SMITH

D This

review

I S C U S S I 0

is meant

ested in measurement an overview of the egies. Only that purport relations with that lytic

to provide

readers

those instruments were to measure a construct

theorists

such

and

ing

with strat-

paralleled studies

those described by theorists. The using these instruments are also the

weakest

methodologically,

reviewed of object

stable

possessing both of differentiation)

levels

tial

ratings

using

intraand

phenomena, laid ifiable throughout

superior the strictly

ence

of significant

patterns out the

others,

ment regarding reflection of the and

clinical

the

past The

these large

reports

several volume

assessment less than

of these

on

is seen constructs is important

described intervening

by

in the

over empirical

by which

as

of the

theo-

construct. If the dimensions along object relations are measured are defined with overly abstract termithe amount of inference required make the ratings and interpret the within the context of the theory

threatens the utility of the instrument. ance needs to be maintained so that nology is both loyal to the theory quantffiable with a low degree It is noteworthy that even researchers ical notions, given

the

and Meehl,4” only for the pur-

dimensions

rise

have efforts

drawn

upon

to strike

to a tremendous

tified

dimensions

tions

are

measured.

similar variability

along

which At

one

JOURNAL

A baltermiand

of inference. though most

this balance

theorethave in iden-

are

Structural

Analysis

but

the

groups

the instrubehavior, of So-

strategies are clearly

because of findings from

led by Blatt

Westen, Piper, and Luborsky the balance more favorably; scious, nomena

pated most

unconscious, while limiting

become lished widely

clear, reliability accepted.

and and

within recent

(the

OR!),

seems to strike they assess con-

and behavioral pheas much as possible

that with further relevant dimensions

to make strateit is antici-

generation of data for assessment

instruments validity

the will

with estabwill become

There are other major issues regarding measurement strategies that remain unresolved, including the question of whether assessing mension captures number two

multiple dimensions or a single diof object relations more adequately the phenomenon. Thus far, the of instruments is split between the

types.

must sions,

Those

who

be measured most notably

largely

on

data

believe

object

along Westen,43

multiple base

from

relations this

dimenbelief

of

affect

assessments

states within self- and other-representations. As noted above, it is conceivable that ments

incorporating of

object

rela-

ments generate

extreme,

the

mension

OF PS\IHOTHERAPY

limited

extreme interpersonal

methodologically, empirical approach

from

(with and

with

the amount of inference required ratings. Although these measurement gies are still in a state of infancy,

have been operationalto remember that,

MacCorquodale variables exist

of quantifying

a

is considerably and tremendous

process

scales

Behavior. These assessment only observable behavior and

work

is in part of theoretical

phenomena

of object relations that from theorists,

theoretical ized. It

retical which themselves nology, both to findings

notions volume

data

reliability)

these studies are difficult to interpret an object relations framework. The

determine

behavior throughThe relative agree-

decades. of literature

variability

pose

largely

of interpersonal individual’s life.

modinflu-

closely

on inferen-

test

interrater

as Benjamin’s

cial rate

in life and by the

relying

At the other measuring

such

that

projective

unidimensional

ranges. ments

structural

relatedness

from low

thematic (implying linking affective/motivational states) dimensions. These intrapsychic down early development

of object

subsequent

consistent psychoana-

as Kernberg:

structures degrees

instruments from Mayman and his had excellent face validity, defin-

inter-

of object relations available assessment

most widely accepted defined by present-day

psychic (implying

earliest colleagues

N

PRACTICE

affect different would

other development””3 results such vary

AND RESEARCH

consistently

proposed that with

assesselewould this diother

34

MEASUREMENT

dimensions ment that

of object relations. may have accomplished

OR! described by Diamond choice of suitable control ment studies needs further ables

such

as

productivity,

IQ,

and

eta!.83 Finally, the groups in assessattention. Vari-

verbal

ability

on object

dictive

validity

theorists

been

iden-

be able

factors in several influence of

studthese

and also to groups such

have

relations

measurement

still

needs

OBJECT

RELATIONS

forts been made to incorporate odologies into psychotherapy come studies, but the results levels of object relatedness may

and

depression

tified as confounding ies.73’97’90 The specific factors

An instruthis is the

OF

an

hypothesized

for

decades.

by clinicians Future

to further

object

these methprocess/outindicate that have the pre-

clarify

address as ours

relations

studies

and should

these

relationships

the issues regarding

put forth the validity

theory

of developmental

to be sorted out. Taking into account all of these cerns, a preliminary effort to compare generalize the findings across all of the

conand stud-

psychopathology and the identification those dimensions of object relations most strongly predict process and outcome psychotherapy. Given the prominence

ies reviewed above can tions as a theoretical

relabeen

these theories in current psychodynamic ory and practice, it is imperative that

operationalized nificant findings. searchers

to

for

be made. construct

empirical The major

date

have

Object has

study with sigefforts of retoward

the

establishment of construct validity, and sures of object relations have correlated diagnosis, degree of symptomatology,

gone

meawith and

age as hypothesized. It seems useful to distinguish between structural and thematic elements of object relations, and assessing across multiple dimensions most valid approach.

may Only

ultimately recently

be the have ef-

to improve

these

by of

assessment

of that in of

theefforts

methodologies

continue.

The author thanks the following Borderline Psychotherapy Research New York Hospital-Westchester advice: Drs. Ann Appelbaum,

members Group

of the of The

Division for their Steve Bauer, John

Glarkin, Otto Kern berg, Paulina Kern berg, Harold Koenigsberg, Larry Rockland, Michael SeIzer, and Frank

Yeomans.

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