Session Abstract: Object relations, or self-other functioning, is recognized as an integral component of one’s personality (e.g., Kernberg, 2016). Object relations develop in childhood and endure into adulthood, forming the basis of one’s sense of self (i.e., identity) and relationships with others (Greenberg & Mitchell, 1983). Use of narrative data allows clinicians and researchers to assess the complex underlying processes that comprise one’s personality. As with all multimethod assessment, one is able to evaluate unique perspectives that might not otherwise be captured by self-reported objective measures (e.g., Hopwood & Bornstein, 2014; Shedler, Mayman, & Manis, 1993). The aim of this symposium is to demonstrate how multi-method approaches can be effective at explicating unique psychological constructs related to self-other functioning when using narrative data in personality assessment. Callie Jowers will present results from a study exploring the relationship between self-reported pathological traits and defensive functioning, with clinician-rated object relations as a potential mediator of this relationship. Particular attention will be paid to the Alternative Model of Personality Disorders and an object relations framework of personality assessment (Clarkin et al., 2020). Mark Blanchard will present results from an innovative project wherein patient-reported doctor-patient relationship quality and healthcare utilization are predicted by a multi-method assessment of a patient’s attachment style, level of differentiation-relatedness, and a measure of flourishing. This project will highlight how the unique interplay between a patients’ relational dynamics and individual strengths can provide a nuanced understanding of interpersonally difficult patients within the healthcare setting. Finally, Caleb Siefert will present a study that highlights the utility of using a multi-item self-rating scale along with expert scores of object relations to rate narrative data. Taken together, these perspectives were able to predict distinct and complementary patterns of self-esteem, interpersonal functioning, and subjective wellbeing. Steven Huprich will serve as the discussant, integrating findings of these three talks and emphasizing their clinical implications.
Chair Information: Mark Blanchard, MA | University of Detroit Mercy
Discussant Information: Steven Huprich, PhD | University of Detroit Mercy
Presentation 1 Title: Do Dimensions of Object Relations Mediate the Relationship Between Pathological Traits and Defenses?
Presentation 1 Abstract: Over the last decade, there has been a major paradigm shift in the way researchers and clinicians conceptualize and assess personality pathology (e.g., Herpertz et al., 2017; Waugh, 2019). New diagnostic systems have been developed (e.g., Alternative Model of Personality Disorders [AMPD; APA, 2013] and the Psychodynamic Diagnostic Manual, 2nd Edition [Lingiardi & McWilliams, 2017]) which include an evaluation of what is considered the core of personality pathology, namely dysfunction in one’s experience of the self and of interpersonal relationships (e.g., Hopwood et al., 2011; Bender et al., 2011), in addition to other structural components of personality pathology. Common across these emerging models is object relations theory (ORT) as an organizing theoretical framework for the conceptualization of personality pathology. ORT suggests that a person’s ability to adaptively navigate adulthood is shaped by early childhood experiences that influence one’s sense of self (i.e., identity) and relationships with others (Greenberg & Mitchell, 1983; Siefert & Porcerelli, 2015).
Given the move toward dimensional models of personality assessment and questions about how best to capture personality pathology, the aim of this project is to assess areas proposed as important from an object relations model of personality assessment, including defensive functioning. The present study will explore object relations as measured by the Object Relations Inventory (ORI; Bers et al., 1993), a potential severity measure aligned with Criterion A of the AMPD (e.g., Bender et al., 2011), as a potential mediator between pathological traits and defensive functioning within a community sample from the United States. Previous research reports correlations between pathological traits and defensive functioning (e.g., Granieri et al., 2017) and personality severity/Criterion A of the AMPD and defensive functioning (e.g., Roche et al., 2018). No study has yet explored the relationship among the ORI and pathological traits, though there is a robust relationship between pathological traits and Criterion A (e.g., Widiger et al., 2019). To address the limitations of self-report methodologies from previous research, the present study will capitalize upon clinician-rated measures of object relations and defensive functioning.
Several hypotheses were devised based upon the extant literature and the ORT model of personality assessment (e.g., Kernberg, 1975; Blatt, 2008; Clarkin et al., 2020; Siefert & Porcerelli, 2015). First, it is expected that pathological traits as measured by the PID-5 domains will be inversely correlated with defensive functioning, such that higher scores on pathological trait domains will correlate with unhealthier levels of defensive functioning. Second, it is expected that poorer object relations will be correlated with less adaptive defensive functioning. Third, it is expected that object relations will mediate the relationship between pathological trait domains and defensive functioning. Results will be discussed in light of the current zeitgeist of personality assessment.
Authors:
Callie Jowers, MS | University of Detroit Mercy
Mark Blanchard, MA | University of Detroit Mercy
Steven Huprich, PhD | University of Detroit Mercy
John H. Porcerelli | University of Detroit Mercy
Presentation 2 Title: Do Relatedness and Flourishing Predict Doctor-Patient Relationships and Healthcare Utilization?
Presentation 2 Abstract: Primary care practice has become a rapidly evolving and increasingly important facet of modern medicine. In the context of greater availability of primary care services and integrated care models, it is important to recognize and address the factors and potential barriers that affect compliance with treatment and positive patient experience and outcome. Understanding how various correlates of physical and mental health impact doctor-patient relationships are central to facilitating better health care utilization. Some predictors of the quality of doctor-patient relationships in primary care include self-reported evaluations of the doctor-patient relationship (Bennett, Fuertes, Keitel, & Phillips, 2011; Fuertes et al., 2007; Porcerelli, Murdoch, Morris, & Fowler, 2014), and measures related to object relations such as attachment (Cassedy et al., 2015) and interpersonal dependency (Porcerelli, Bornstein, Porcerelli, & Arterbery, 2015), though object relations themselves in the context of these relationships have not been thoroughly assessed. Similarly, associations between pathological personality and negative evaluations of relationships have been well documented; however, less is known about how measures of wellbeing, or flourishing, impacts the experience of others (Boyer, 2008; Oldham, 1994), especially with respect to giving and receiving care.
The aim of this study will be to explicate how a patient’s attachment style and capacity for differentiation-relatedness impact their perceptions of doctor-patient relationships and their utilization of healthcare services. In this context, patients’ scores on a measure of flourishing (PERMA Profiler; Seligman, 2011) will be included in order to illuminate individual strengths. This research is innovative in that it provides a deeper appreciation of how to better identify obstacles and barriers to health care utilization, with special consideration for doctor-patient relationships. Given that health care utilization is of global concern, in the interest of reducing overall healthcare costs, identifying these issues is important to clarify what aspects of self and relational functioning interfere with or aid to compliance with treatment.
Several hypotheses were generated to assess attachment, object relations, and flourishing in healthcare. First, it is expected that healthier levels of differentiation-relatedness and more secure attachment styles will predict higher rated doctor-patient relationship quality and more appropriate levels of healthcare utilization, while more pathological levels of differentiation-relatedness and attachment security will predict lower-rated doctor-patient relationship quality and more inappropriate levels of healthcare utilization. Second, each of the five subscales of the PERMA Profiler will predict higher rated doctor-patient relationship quality and more appropriate levels of healthcare utilization while lower scores will predict lower rated doctor-patient relationship quality, as measured by the patient-doctor relationship scale (PDRQ; Van der Feltz-Cornelis, Van Oppen, Van Marwijk, De Beurs, & Van Dyck, 2004) and more inappropriate levels of healthcare utilization. Lastly, statistically significant scores on the subscales of the PERMA Profiler along with attachment styles and object relations (differentiation-relatedness) together will better predict doctor-patient relationship quality and healthcare utilization experienced among participants than either model along. Results and their implications will be discussed.
Authors:
Mark Blanchard, MA | University of Detroit Mercy
Callie Jowers, MS | University of Detroit Mercy
John H. Porcerelli | University of Detroit Mercy
Steven Huprich, PhD | University of Detroit Mercy
Presentation 3 Title: A Multi-Method Approach to Rating Narratives: Could Respondent Ratings be Useful?
Presentation 3 Abstract: Narratives have a long history of use in personality assessment and research. Historically, researchers and clinicians have relied on expert rating systems to code for key aspects of personality. The present paper explored the utility of a multi-item self-rating scale, the Other and Self Impact Scales (OaSIS), allowing respondents to rate how events within narratives impacted their self view and view of others. In this study, 116 college students provide autobiographical narratives of interpersonal interactions. Narratives were generated under two instruction sets. Fifty-nine participants generated narratives using Luborsky’s Relational Anecdote Paradigm and 57 participants generated narratives using a self-defining memories recall task. All participants rated their narratives using the OaSIS. All narratives were also rated by expert raters using the Social Cognitions and Object Relations Scales – Global Method (SCORS-G). SCORS-G and OaSIS scales were then used to predict participant’s trait ratings for subjective well-being and interpersonal functioning. As expected, OaSIS scales were related to the relational-affective factor and self-functioning factor of the SCORS-G, but not the cognitive factor. OaSIS scales were also predictive of participant’s trait ratings for self-esteem, adult attachment, and interpersonal functioning. The overall pattern of results suggests that the OaSIS complements expert narrative ratings. Additionally, the findings support the theory that a multi-method approach to rating narratives may have much to offer those working with narratives.
Authors:
Caleb J. Siefert | University of Michigan-Dearborn
Callie Jowers, MS | University of Detroit Mercy
Lena Rammouni
Jenelle Slavin-Mulford