The Assessment of Object Relations Phenomena in Adolescents: Tat and Rorschach Measu

by Kelly; Francis D.

• ISBN13: 9780805822359
• ISBN10: 0805822356
• Edition: 1st
• Format: Hardcover
• Copyright: 1997-04-01
• Publisher: Routledge

Summary

This book offers clinicians a long-awaited comprehensive paradigm for assessing object relations functioning in disturbed younger and older adolescents. It gives a clear sense of how object relations functioning is manifest in different disorders, and illuminates how scores on object relations measures are converted into a therapeutically relevant diagnostic matrix and formulation. Outlining the process of object relations assessment, Kelly presents vividly detailed cases of a range of disorders including anorexia nervosa, borderline states, depressive disorders, and trauma. The cases portray the vicissitudes of object relations functioning and disruption that result in a unique structural developmental composite for a given adolescent. A major concern is demonstrating the utility and validity of two object representation measures--The Mutuality of Autonomy Scale (MOA) and The Social Cognition Object Relations Scale (SCORS)--that are the main ones employed in the assessment of adolescents. MOA and SCORS scores facilitate a multidimensional understanding of the nuances of an adolescent's object relations functioning, and provide clinicians with organized, theory-based data leading to clear, specific treatment directions and guidelines and appropriate therapeutic programming. The book addresses the following questions: * Is individual psychotherapy indicated--will this adolescent benefit from an insight-oriented approach? * What are the likely directions that transference parameters will take in the treatment? * What types of countertransference reactions are likely to be anticipated in a given patient? * Is medication likely to be helpful in making this adolescent more accessible for treatment? Focusing only on adolescents, covering both the TAT and the Rorschach, and utilizing object relations theory as its major interpretive foundation, the book offers practitioners an alternative to general references based on a more actuarial, nomothetic, and atheoretical interpretive approach. It reflects one school of contemporary thought in projective assessment--one that advocates a more phenomenological, theory-based approach to test application and interpretation.

Table of Contents

Preface	xi
Introduction	1	(8)
1 Diagnostic Difficulties in Adolescent Psychiatry: Limitations of DSM-IV and the Role of Projective Tests in Developmental Assessment	9	(10)
2 Object Relations Assessment and Functioning in Adolescence: Theoretical and Clinical Considerations	19	(10)
Case Illustration: Teddy, a Narcissistic Adolescent	23	(6)
3 Object Representation Assessment in Adolescence: TAT and Rorschach Research in Relation to Different Clinical Populations	29	(14)
Rorschach Object Representation Research With Adolescents: Idiographic and Nomothetic Findings Emphasizing the MOA	33	(3)
Object Representation Rorschach Research Emphasizing Other Measures	36	(2)
TAT and Rorschach Representation Research With Adolescents: Idiographic and Nomothetic Findings Emphasizing the SCORS	38	(5)
4 Object Representation Scales	43	(26)
MOA	43	(6)
SCORS	49	(3)
Complexity of Representations of People	52	(3)
Affect-Tone of Relationship Paradigms	55	(3)
Capacity for Emotional Investment in Relationships and Moral Standards	58	(6)
Understanding of Social Causality	64	(5)
5 The Assessment of Object Representation in Normal Adolescents	69	(21)
Case 1: Keith, a 13-Year-Old Male	72	(3)
Case 2: Susan, a 14-Year-Old Female	75	(2)
Case 3: Justin, a 15-Year-Old Male	77	(3)
Case 4: John, a 16-Year-Old Male	80	(3)
Case 5: Cathy, a 17-Year-Old Female	83	(3)
Case 6: Elizabeth, an 18-Year-Old Female	86	(3)
Summary	89	(1)
6 Introduction to Clinical Case Illustrations	90	(43)
Early Adoliscence Clinical Illustrations	91	(11)
Case 7: Kimberly, Adjustment Difficulties in a 14-Year-Old	91	(3)
Case 8: Wes, Severe Conduct Disorder in a 13-Year-Old	94	(4)
Case 9: Rob, Borderline Personality Organization in a 13-Year-Old	98	(4)
Middle Adolescence Clinical Illustrations	102	(16)
Case 10: Linda, Borderline Personality Organization in a 15-Year-Old	102	(6)
Case 11: James, Conduct Problems and Depressive Disorder in a 16-Year-Old	108	(4)
Case 12: Marla, Acute Affective Psychotic Reaction in a 16-Year-Old	112	(6)
Late Adolescence Clinical Illustrations	118	(15)
Case 13: Terri, Anorexia Nervosa and Depression in an 18-Year-Old	118	(4)
Case 14: Sheri, a Neglectful and Abused 18-Year-Old Adolescent Mother	122	(5)
Case 15: Tyler, Acute Psychotic Reaction in an 18-Year-Old	127	(6)
7 Pathways of Trauma: The Impact of Chronic, Complex Abuse and Neglect Experiences on Object Representations and Relatedness	133	(20)
Case 16: Joey, a Youngster With a History of Physical, Sexual, and Emotional Abuse	138	(4)
Case 17: Daniel, Early Abandonment, Physical and Emotional Abuse	142	(4)
Case 18: Amelia, a History of Chronic, Complex Trauma	146	(5)
Summary	151	(2)
8 From Assessment to Treatment Planning: The Development of the Psychodynamic Formulation	153	(17)
Part I: The Summarizing Statement	155	(1)
Part II: Description of Nondynamic Factors	155	(1)
Part III: Psychodynamic Explanation of Central Conflicts	156	(1)
Part IV: Predicting Reponses to Therapeutic Interventions	157	(1)
Three Illustrative Psychodynamic Formulations	157	(2)
Case 19: Bill, a 13-Year-Old With Depression	159	(3)
Case 20: Amber, a 15-Year-Old With Separation Individuation Difficulties	162	(3)
Case 21: Emily, a 19-Year-Old With a Severe Adjustment Disorder and Depression	165	(4)
Summary	169	(1)
9 Object Representation and Changes in Clinical Functioning: Positive and Negative Therapeutic Sequelae in Adolescence	170	(17)
Case 22: Tim, an Adolescent Sexual Offender	172	(7)
Case 23: Michael, an Adolescent With Depression, Conduct Problems, and Faltering Personality Development	179	(6)
Summary	185	(2)
10 Concluding Observations and Remarks	187	(5)
References	192	(11)
Author Index	203	(4)
Subject Index	207