The relationship between patient object relations and the therapeutic alliance in a naturalistic psychotherapy sample.

OBJECTIVES: This study examined the relationship between patients' object relations and interpersonal process in psychotherapy. Namely, we tested the hypothesis that the quality of patients' object relations is positively associated with both patient- and therapist-rated alliance quality. DESIGN: Psychotherapy was administered naturalistically, with quantitative data collection before and during treatment. METHODS: Participants included 73 adult outpatients and 23 therapists at two mental health clinics. Using the Bell Object Relations and Reality Testing Inventory, we measured four dimensions of patients' object relations at baseline-alienation, insecure attachment, egocentricity, and social incompetence. Using the Working Alliance Inventory, we measured alliance from patient and therapist perspectives. Control variables included time, patient demographics, symptom severity, and clinic. We employed hierarchical linear modelling to analyse data with a nested structure, with 138 sessions at Level 1, 73 patients at Level 2, and 23 therapists at Level 3. RESULTS: Patient alienation and insecure attachment were associated with lower patient-rated alliance, while egocentricity was associated with higher patient-rated alliance. Patients' object relations were not significantly associated with therapist-rated alliance. On average, patients perceived the alliance more positively than their therapists, with a weak positive correlation between the alliance perspectives. CONCLUSIONS: The results suggest that object relation dimensions may be important patient characteristics for forecasting therapeutic relationship quality. They also call for more attention to differences between alliance rating perspectives. PRACTITIONER POINTS: Treatment may benefit from more attention to the quality of patients' object relations. If patients present with high levels of alienation and insecure attachment, therapists may need to pay especially close attention to the therapeutic alliance, and prudently address any ruptures in its quality. When monitoring the alliance quality, it is important to consider that patients and therapists may have different perspectives. Therapists relying solely on their own perceptions are at risk of missing alliance difficulties, and patients' object relations may be uniquely predictive of their own sense of the alliance. Therefore, it may be helpful to ask patients in session and through standardized measures for feedback on how they perceive the goals and tasks of treatment and the emotional bond with their therapist. Again, any alliance tensions could then be addressed directly as a means to maintaining engagement in the service of better outcome.

Cognición espacial: posiciones egocéntrica y alocéntrica en un grupo con Síndrome de Asperger / Spatial cognition in an Asperger syndrome group: egocentric and allocentric stances

Se han propuesto tres aproximaciones que intentan explicar las peculiaridades del Síndrome de Asperger (SA): disfunción ejecutiva, pobre teoría de la mente o dificultades en la coherencia central. En 2005, Frith y Vignemont proponen una desconexión entre posiciones egocéntrica a alocéntrica, planteando una nueva línea de caracterización del SA. Objetivo: En el presente estudio se comparó el desempeño del tránsito entre posiciones egocéntrica y alocéntrica, en un grupo de cinco niños con SA. Método: El grupo estuvo conformado por 4 niños y 1 niña, con edad promedio de 10 años. Se realizó una valoración detallada a fin de confirmar el diagnóstico y se aplicaron subescalas de la Evaluación Neuropsicológica Infantil. Se reporta el análisis del desempeño en la subescala Habilidades Espaciales. Resultados: Se observa un desempeño dentro del rango promedio observando diferencias estadísticamente significativas entre subdominios que conforman la subescala (014<0.05 F friedman), así como en las respuestas correctas cuando utilizaron marcos de referencia alocéntricos y egocéntrico en tareas de comprensión (gl 2, 0.041<0.05 Q Cochran) y expresión (gl 2, 0.022<0.05 Q Cochran) derecha-izquierda. Conclusión: En el caso del SA, se observa predominio del uso de la posición egocéntrica. El desempeño alocéntrico de los participantes es más eficaz cuando establecen relaciones desde un objeto dinámico vs estático. Se destaca la importancia de realizar un diagnóstico meticuloso del SA, a fin de valorar si las peculiaridades observadas en cognición espacial han sido generalizadas erróneamente a otros Trastornos del Espectro Autista debido a un diagnóstico equivocado.

Asperger Syndrome (SA) has been explained by three approaches: executive dysfunction, impaired theory of mind and central coherence. In 2005, Frith and Vignemont suggest a new approach, based in disconnection between egocentric and allocentric stances. The present study aimed to compare performance´s group of five children with AS in egocentric-allocentric transit task. Four boys and a girl, whose average age was 10 years old, formed the group. A comprehensive assessment confirmed de AS diagnostic. Children were assessed with Evaluacion Neuropsicológica Infantil subtests, and we report the Spatial Abilities subtest analysis. Standard scores were obtained by the group in average values, but there were significant differences (014<0.05 F friedman) between subdomains assessed by Spatial Abilities subtest. We also found significant differences in egocentric-allocentric stances in spatial notion understanding task (gl 2,0.041<0.05 Q Cochran), and spatial notion expression task (gl 2, 0.022<0.05 Q Cochran). Conclusion: AS group prevail taking egocentric stance. Allocentric performance is commonly efficient if individuals take stance from dynamic than static object. We highlight the importance of an accurate and comprehensive assessment in AS diagnosis to avoid generalization of AS features to another Spectrum Autistic Disorders because of a mistaken AS diagnosis.