Dvir Reznik | The (old) Blog

Signing off the dissertation

If memory serves me well, this is the first post that is not focused on me. This post honors my significant other, D, who came one step closer to becoming a clinical psychologist by submitting her Ph.D dissertation earlier this week. The dissertation took 4.5 years (!) to complete, part of a very long process that has been going on for 10 years now, with 2 more years to go (equivalent of an internship). Considering we met some 6 years ago, this is quite a journey to go through as a couple.

D – I am in-love with you, deeply, and want to live with you forever.  And… NYC – here we come !

Ph.D Dissertation

The abstract of her dissertation proposal is available hereunder. Enjoy.

Title:

Object Relations in Schizophrenia Spectrum Disorders: Assessment and Predictive Value for Symptoms, Functioning, and Quality of Life

Abstract:

In the last three decades schizophrenia spectrum disorders were studied extensively from a biological-genetic-structural perspective. This perspective had a significant contribution to our understanding of these disorders (e.g., Jaaro-Peled et al., 2009). However, inconsistency in research findings and the complexity associated with the interpretation of such findings suggest that biological, genetic and structural models may be insufficient for accounting for the variability in the symptoms associated with schizophrenia spectrum disorders. Further, biological-genetic-structural models may be limited in their capacity of explaining individual differences such as coping skills, level of functioning, and chances of adjustment for people suffering from the same disorders on the spectrum (Bentall & Fernyhough, 2008; Harrow & Jobe, 2007). The current thesis aims to address these limitations by investigating schizophrenia spectrum disorders from a psychological perspective and more specifically from object relations theory perspective.

Object relations theories assume that early interpersonal relationships are internalized as mental representations of self-object interactions. These representations consist of cognitive, affective, and experiential information regarding the self, objects, and the interaction between them (Blatt, Auerbach & Aryan, 1998). Classical object-relations theories suggest that deficiencies in the early interactions may lead, in extreme circumstances, to psychotic disorders and schizophrenia in adulthood (Fairbairn, 1954; Winnicott, 1965).

Schizophrenic disorders were described by various theoreticians and researchers in terms of impaired (chaotic and primitive) self and object representations, boundary disturbances in mental representations and failure to achieve more integrated levels of object-relations development (Blatt & Wild, 1976; Guntrip, 1968; Ryan & Bell, 1984). In addition, object relations’ theories suggest that different psychiatric disorders may vary in their severity of object relations impairment. However, these theories do not explicitly address the heterogeneity of object relations’ developmental levels and quality within schizophrenia spectrum disorders. The current thesis attempted to examine whether these differences in object relations are linked with specific symptomatic and functional variations in these schizophrenia spectrum disorders. Specifically, in this thesis we examined the role of object relations and their benevolence and developmental level, in predicting severity of the symptoms, level of functioning, and quality of life of individuals suffering from schizophrenia spectrum disorders.

In order to address these important questions, 85 out-patients who met DSM-IV-TR (American Psychiatric Association, 2000) criteria for schizophrenia spectrum disorders, were assessed twice with a five-month interval between the two assessments. In order to evaluate the quality, complexity, and the developmental level of object relations, we used four central instruments in the field of object relations’ assessment. Two of these measures – SCORS and MOA, were derived from well known implicit psychological tests (TAT and Rorschach respectively). The other two measures – ORI and D-R – stem from a standard narrative procedure that includes spontaneous descriptions of significant others. We hypothesized that these measures would tap into the broad theoretical construct of object relations, each from a different perspective. A series of Pearson correlations confirmed this hypothesis. Consistent with current research, our analyses revealed two central components of the internalized representations: a cognitive-structural component and an affective-qualitative component (Blatt & Auerbach, 2000). Also as expected, without psycho-therapeutic intervention, object relations’ developmental level, their complexity and their benevolence, remained stable over the course of the 5-months interval.

Next, we examined whether measures of object relations at the initial wave of measurement (Time 1) predicted symptomatic and functional aspects, and perceived quality of life five months later (Time 2). A series of hierarchical regression analyses revealed that higher developmental level of object relations, as well as more benevolent and complex object relations were linked with lower severity of positive and negative schizophrenic symptoms, and better functioning and quality of life. These results remained significant while controlling for participants’ age and gender. When varied measures from different instruments of object relations were introduced in one model, each showed a unique contribution to the prediction of schizophrenia symptoms severity, functioning, and quality of life. This suggests that the consideration of various aspects of object relations may be important when assessing these characteristics of schizophrenia spectrum disorders. These findings also supported the hypothesis that the variance in the level of benevolence and development of object relations play a role in the explanation of symptomatic and functional heterogeneity that commonly characterize these disorders.

Finally, classical object-relations theories (e.g.,: Fairbairn, 1954; Winnicott, 1965) suggest that the level of deficiencies in an individuals’ primary environment influence the level of psychopathology and therefore symptom severity of various mental disorders. The severity of symptoms is then believed to be linked with impairment in the level of functioning. Consequently, we assumed that object relations are only indirectly linked with individuals’ level of functioning. Using a mediation model (Shrout & Bolger, 2002), our finding supported this hypothesis.

The current thesis expanded our knowledge of the associations between object relations and schizophrenia spectrum disorders. Beyond the theoretical contribution of the current study, the finding that higher developmental level and benevolence of object relations predict better outcomes for patients with schizophrenia spectrum disorders, and gives hope and optimism regarding the prognosis of these patients. Even in these severe mental disorders, in which there is a strong genetic or biological basis, more benevolent and developed representations of interpersonal relations may play an important role in positive prognosis regarding the severity of symptoms, level of functioning, and quality of life of the individuals suffering from the disorders.

The findings of this thesis have practical clinical implications. In accordance with our findings, several recommendations regarding the choice of measures to evaluate object relations developmental level, benevolence, and complexity were suggested. These recommendations have the potential to enable clinicians or researchers to optimally choose the most efficient and informative combinations of various measures of object relations when addressing the prognosis of patients with schizophrenia spectrum disorders. Finally, the results of the current study may be suggestive of the need to integrate object relations’ interventions with conventional psychiatric interventions when treating this population.

The current study aimed to promote a meaningful dialogue between the clinical psychology world and the psychiatric world. The findings of the study demonstrated that combining these worlds may lead to a more profound and more broad comprehension of schizophrenia spectrum disorders. It is our hope that the current study will lay the foundations for expanding the research of mental representations and object relations in schizophrenia spectrum disorders, as well as in other psychiatric disorders.