Åke Granberg

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The introjection of self-image and its relevance for treatment outcome in severely disturbed psychiatric patients

I BOKEN "THE introjection of self-image and its relevance for treatment outcome in severely disturbed psychiatric patients" av Åke Granberg, utforskas sambandet mellan självbild och behandlingseffekter hos svårt störda psykiatriska patienter. Genom en grundlig analys av hur föräldrars beteenden påverkar patienternas självuppfattning, belyser Granberg viktiga aspekter av psykiatrisk behandling och dess resultat.

• Boken fokuserar på introjektion av självbild i psykiatrisk vård.

• Den analyserar relationer mellan föräldrar och patienters självbild.

• Behandlingseffekter utvärderas över en femårsperiod.

Granbergs forskning bygger på teorier från Benjamin och Luborsky, där han använder metoder som Structural Analysis of Social Behavior (SASB) och Core Conflictual Relationship Theme (CCRT) för att studera patienternas önskningar och självbilder. Genom att klassificera patienter enligt Kernbergs diagnostiska kriterier, undersöker han hur olika personlighetsorganisationer - neurotiska, borderline och psykotiska - påverkar behandlingsresultat.

I de olika studierna presenteras intressanta fynd, såsom att borderline-patienter ofta har en negativ självbild kopplad till sina föräldrar, medan psykotiska patienter uppvisar svårigheter med separation från modern. Dessa insikter ger en djupare förståelse för hur tidiga relationer formar individens självbild och därmed påverkar deras psykiska hälsa.

Avslutningsvis bidrar "The introjection of self-image and its relevance for treatment outcome in severely disturbed psychiatric patients" med värdefull kunskap om hur självbilden kan fungera som en indikator på behandlingsframgång. Boken är av stor betydelse för yrkesverksamma inom psykiatri och psykologi, samt för forskare som intresserar sig för relationen mellan interpersonella dynamiker och psykisk ohälsa.

The aim of the studies in this thesis was to analyse self-image (introject) and wishes from an interpersonal viewpoint. The focus was on how perceptions of the parents became introjected self-images and the relatin between these introjects and treatment outcome in a cohort of severely distrubed psychiatric patients participating in milieu treatment programs. The self-image was the introject as it has been developed by Benjamin in the Structural Analysis of Social Behavior (SASB) and the patients' wishes were studied with Luborsky's Core Conflictual Relationshop Theme method (CCRT). The patients were classified and analysed using the diagnostic criteria of Kernberg's Structural Interview, as having a neurotic (NPO), a borderline (BPO), or a psychotic personality organisation (PPO). The treatment was evaluated assessing the patients change between intake and follow-up five years later in terms of self-image, symptoms and psychological functioning.

The first study compared BPO and PPO patients' relations between their parents acting towards them and their self-images. The main conclusions were the BPO patients had a negative attachment to their parents also mirrored in a negative self-image while the PPO patients showed a poor separation from the mother who was the only parent that influenced their self-image.

In the second study the PPO patients' wishes were compared to those of a normal group. The PPO patients had divergent descriptions of their interpersonal relations from the normal group. They expressed very few narratives of interpersonal relations and their wishes were not directed towards other persons but were about things that would happen to them without their agency.

In the third study the relation between initial self-image ratings and outcome was compared for a PPO group and a non-PPO group. Outcome was assessed with two measures reflecting the patients' subjective perspective and researchers' judged perspective. For both patient groups a negative self-image resulted in a better subjective outcome. This result was more marked for the non-PPO patients. For them more self-control was also related to a better judged outcome.

Finally the fourth study focused on the change of the affiliative and control dimensions of self-image following treatment. The three diagnostic groups all had a more affiliative self-image getting closer to that of a normal group while there was little change in the control dimension. It was suggested that the difference between the self-images of the psychotic and borderline patients and the prevalent opinion of their relating capacity might lead to interpersonal problems.