Changes in Object Relations Changes in Object Relations following following

Time Focused Group Time Focused Group Psychotherapy with Psychotherapy with

Women who Experienced Women who Experienced Childhood AbuseChildhood Abuse

Gerardine Curtin PhD Gerardine Curtin PhD HSE W/Queens UniversityHSE W/Queens University,, Belfast Belfast

Dr KarenTrew, QueensDr KarenTrew, Queens University, BelfastUniversity, Belfast

Dr Raman Kapur, Threshold,BelfastDr Raman Kapur, Threshold,Belfast

Psychological SequelaePsychological Sequelae

• Greater psychiatric distress and Greater psychiatric distress and poorer interpersonal functioning poorer interpersonal functioning (Callahan, Price & Hilsenroth, 2003; DiLillo, 2001).(Callahan, Price & Hilsenroth, 2003; DiLillo, 2001).

• Impairment in object relatedness-Impairment in object relatedness-

Increased interpersonal Increased interpersonal hypersensitivityhypersensitivity

Maladaptive relational patterns Maladaptive relational patterns (Elliott, 1994).(Elliott, 1994).

MEASURING TREATMENT MEASURING TREATMENT EFFECTIVENESSEFFECTIVENESS

• Typically:Typically:– Behaviour Behaviour – Perceived mental healthPerceived mental health

**Symptom / QOL checklistsSymptom / QOL checklists

**Ratings of mental health Ratings of mental health (Eklund(Eklund & Nilsson & Nilsson, , 1999) 1999)

PSYCHODYNAMIC PSYCHODYNAMIC PSYCHOTHERAPYPSYCHOTHERAPY• Change extending beyond:Change extending beyond:

– Manifest symptomsManifest symptoms

– BehavioursBehaviours

• Alterations in the ‘structure of the Alterations in the ‘structure of the

personality’ personality’ (Zilberg (Zilberg et al,et al,

1991)1991)

Measuring Intrapsychic Change Measuring Intrapsychic Change Percept Genetic Object Relation Test (Nilsson & Percept Genetic Object Relation Test (Nilsson &

Svensson,1999)Svensson,1999)• Percept –GenesisPercept –Genesis

•Perception and personality closely relatedPerception and personality closely related

•Bypass the defences that could bias self-Bypass the defences that could bias self-report.report.

•subliminal presentation accesses subliminal presentation accesses attachment systems at unconscious level attachment systems at unconscious level

• Questionnaires Questionnaires – Conscious appreciation of attachment Conscious appreciation of attachment

figures and relationships figures and relationships (Titelman & (Titelman & Nilsson, 2002)Nilsson, 2002)

PORTPORTPercept Genetic Object Relation Test(Nilsson & Percept Genetic Object Relation Test(Nilsson &

Svensson,1999)Svensson,1999)

•Human interactions 1Human interactions 1stst OR OR phases of phases of developmentdevelopment

•Attachment Theme (Bowlby, Attachment Theme (Bowlby, 1969)1969)

•Separation Theme Separation Theme (Mahler, 1965) (Mahler, 1965) and and •Oedipal ThemeOedipal Theme

•Administered tachistoscopicallyAdministered tachistoscopically

MEASURESMEASURES• Percept –genetic Object Relation Test Percept –genetic Object Relation Test

PORT PORT (Nilsson & Svensson,1999)(Nilsson & Svensson,1999)

• The Symptom Checklist –90– Revised The Symptom Checklist –90– Revised (Derogatis,1994)(Derogatis,1994)

• The Inventory of Interpersonal Problems The Inventory of Interpersonal Problems (Horowitz et al.,2000)(Horowitz et al.,2000)

• Adherence Scale for Group Adherence Scale for Group Psychotherapy Psychotherapy (Ogrodniczuk & Piper,1999) (Ogrodniczuk & Piper,1999)

• Two clinical interviews Two clinical interviews • Demographic questionnaire Demographic questionnaire • Client Satisfaction QuestionnaireClient Satisfaction Questionnaire (Larsen ,et al 1979(Larsen ,et al 1979))

AIMSAIMS

• To measure intrapsychicTo measure intrapsychic,interpersonal & ,interpersonal & symtomatic symtomatic changes using the PORTchanges using the PORT ,SCL-90- ,SCL-90-Rand IIP-64Rand IIP-64

• To compare and contrast treatment with To compare and contrast treatment with matched controls on the measures usedmatched controls on the measures used

• To compare and contrast intrapsychic with To compare and contrast intrapsychic with interpersonal & symptomatological changesinterpersonal & symptomatological changes

• To evaluate the effectiveness of the To evaluate the effectiveness of the interventionintervention

Design And ProcedureDesign And Procedure

Women with a Women with a

-history of childhood abuse -history of childhood abuse whowho

-had completed individual therapy were -had completed individual therapy were screened by clinical interview for screened by clinical interview for suitability suitability

--Treatment programmeTreatment programme

– Participation in researchParticipation in research

Quasi-experimentalQuasi-experimental

All screened participants in All screened participants in

– Treatment Group, n=17 Treatment Group, n=17

– Control Group (no intervention) n=10 Control Group (no intervention) n=10

Were assessed at:Were assessed at:

– Time 1 (Before treatment)Time 1 (Before treatment)

– Time 2 (One year later)Time 2 (One year later)

Baseline similarityBaseline similarity of Both Groupsof Both Groups EstablishedEstablished

- Demographically Demographically

- Dependant Variables - Clinically Dependant Variables - Clinically

– Representative of Service UsersRepresentative of Service Users

Data AnalysisData Analysis

QuantitativeQuantitative

QualitativeQualitative

ClinicalClinical

2 1 Attachment Theme

4

3.5

3

2.5

2

Control group Treatment group group

Attachment Theme Changes in Mean Scores Time 1- Time 2

2 1 Separation Theme

5

4.5

4

3.5

3

2.5

2

Control group Treatment group group

Separation Theme Changes in mean scores Time 1-Time 2

2 1 Oedipal Theme

3.2

3

2.8

2.6

2.4

2.2

2

Control group Treatment group group

Oedipal Theme Changes in Mean Scores Time 1-Time 2

2 1 IIP-64 Total

66

64

62

60

58

56

54 Ch

ange

s in

Mea

n S

core

s T

ime

1 a

nd

Tim

e 2

Control group Treatment group

group

Interpersonal Problems IIP-64 TOTAL Score

2 1 SCL-90-R

70

67.5

65

62.5

60

57.5

55 Ch

ange

s in

Mea

n S

core

s T

ime

1-Tim

e 2

Control group Treatment group

group

Psychological Symptoms Global Severity Index

PORT Group Probability Effect Size

Treatment 0.0009* Attachment Control 0.9883

1.142 -0.085

Treatment 0.0012* Separation Control 0.0078

1.32 1.25

Treatment 0.0744 Oedipal Control 0.6094

0.72 0.17

GSI Treatment 0.0017* 0.56 Control 0.2227 0.36 Total Treatment 0.1412 0.44 Control 0.1211 0.32

Mann Whitney U Test Mann Whitney U Test ResultsResults

Variable Group n Mean Score Probability

Treatment 17 17.09 Difference in Attachment Scores

Control 10 8.75 0.0138

Treatment 17 15.53 Difference in Separation Scores

Control 10 11.40 0.2046

Treatment 17 14.74 Difference in Oedipal Scores

Control 10 12.75 0.5404

Treatment 17 14.29 Difference in GSI

Control 10 13.50 0.8225

Treatment 17 13.97 Difference in Total

Control 10 14.05 1.0000

ODDS RATIO ESTIMATEODDS RATIO ESTIMATE

95% Wald Effect

Point Estimate Confidence

Limits

Difference in

Attachment Scores Time 1 – Time 2

1.982 1.065 3.689

Difference in Separation Scores Time 1 – Time 2

1.257 0.695 2.272

Difference in Oedipal Scores Time 1 – Time 2

1.108 0.578 2.126

Difference in GSI Time 1 – Time 2

0.923 0.787 1.083

Difference in IIP Time 1 – Time 2

0.990 0.849 1.153

Salkovskis (1995) ‘Hour-Glass’ Salkovskis (1995) ‘Hour-Glass’ ModelModel

Mann-Whitney U-Test Comparison of Time 1 Scores:

Comparison Group versus Treatment Group

Statistic/Result Attachment

Theme Total

Separation Theme Tota1

Oedipal Theme Total

G.S.I SCL-90-R

Total IIP-64

Z-Score -0.92 -0.41 -0.39 -0.63 -1.18 T-Approximation Significance (Two-Tailed)

0.3679 0.6842 0.7014 0.5344 0.2483

Differences in the Groups T1-T2Differences in the Groups T1-T2

Wilcoxon Signed Ranks Tests •Changes T1-T2 Treatment Group•Changes T1-T2 Control Group •Five Measures

*Three PORT Themes *Two Global Scores GSI (SCL-90-R) & Total (IIP-64)

Differences Between the Differences Between the Groups T1-T2Groups T1-T2

•Mann-Whitney U tests to compare the groups at the beginning and again one year later

• Effect size – – Cohen’s d and Odds Cohen’s d and Odds RatioRatio