Harpaz-Rotem Ilan, Blatt Sidney J
Department of Psychiatry Yale University in New Haven, New Haven, Connecticut 06511, USA.
Psychiatry. 2009 Spring;72(1):32-49. doi: 10.1521/psyc.2009.72.1.32.
Processes that lead to normal development of the representations of self and others are also central to understanding processes of therapeutic change. In long-term, intensive, psychodynamically oriented, inpatient treatment of seriously disturbed, treatment-resistant adolescents and young adults, we found that changes in the level of differentiation-relatedness in patients' self-representation were primarily associated with changes in the level of differentiation-relatedness of their description of their therapist. A best-fit model indicated that change in the patient's description of the therapist and of a self-designated significant other outside the family added significantly to the explained variance predicting change in self-representation. Exploratory structural equation modeling also suggested that patients' growing recognition of the therapeutic relationship (measured by a more mature representation of the therapist) is associated with changes in the patients' overall level of clinical functioning. These results add further support to the importance of the therapeutic relationship in building more differentiated and integrated representations of self and of significant others.
导致自我和他人表征正常发展的过程对于理解治疗性改变的过程也至关重要。在对严重困扰、治疗抵抗的青少年和年轻成年人进行的长期、密集、心理动力学导向的住院治疗中，我们发现患者自我表征中分化-关联性水平的变化主要与他们对治疗师描述的分化-关联性水平的变化相关。一个最佳拟合模型表明，患者对治疗师以及家庭外自我指定的重要他人的描述变化，显著增加了预测自我表征变化的解释方差。探索性结构方程模型还表明，患者对治疗关系的日益认识（通过对治疗师更成熟的表征来衡量）与患者临床功能的整体水平变化相关。这些结果进一步支持了治疗关系在构建更分化和整合的自我及重要他人表征中的重要性。
