/2((0%*6!):!$**0%!7#2*D0!2*&!(#0$%!%0<2($)*!Z$(#!12($0*(! 7#2%27(0%$6($76!2*&!)B(7)90!$*!2!1647#)2*2<4($7!#)61$(2<$C2($)*E3260&! (%02(90*(!:)%!10%6)*2<$(4!&$6)%&0%0&!12($0*(6!! V0%9)(0_!5>_!A)Z47M_!F>_!AB4(0*_!/>_!V0%#206(_!e>_!V0%()990*_!H>_!V2*&0*00&0_!F>_!8)%Y0<04*_!i>_!G!/0B6M0*6_!i>! [+,--^>!/2((0%*6!):!$**0%!7#2*D0!2*&!(#0$%!%0<2($)*!Z$(#!12($0*(!7#2%27(0%$6($76!2*&!)B(7)90!$*!2!1647#)2*2<4($7! #)61$(2<$C2($)*E3260&!(%02(90*(!:)%!10%6)*2<$(4!&$6)%&0%0&!12($0*(6>! 8B)+)?@B&'(A?-"B"LA&@+*&'(A?-",-%#@:A _!-b! []^_!P,PE-P>! F<2((_!Q>!i>![+,,]^>! 2P:%#)%+?%&"!&;%:#%(()"+^&1-%"#%,)?@BO&8B)+)?@B&@+*&3%(%@#?-&'%#(:%?, $Y06>!K26#$*D()*_!O8?! =90%$72*!/647#)<)D$72! F<2((_!Q>!i>![+,,b mC&'"B@#),)%(&"!&2P:%#)%+?%(^&3%B@,%*+%((&@+*&6%B!V;%!)+),)"+&)+&'%#("+@B),A&;%<%B":$%+,O& '(A?-":@,-"B"LA&@+*&,-%&1-%#@:%>,)?&'#"?%(( >!K26#$*D()*_!O8?!=90%$72*!/647#)<)D$72!! W(*&,!>-001(3 ! The efficacy and effectiveness of psychodynamic treatments for personality disorders (PDs), and for borderline patients in particular, have been demonstrated in a number of randomized controlled trials as well as in naturalistic pre–post studies. In particular, these treatments have been shown to lead to clinically significant improvements in symptom levels, interpersonal functioning and global adjustment. Yet, the fundamental premise of psychoanalytic theories of PD is that besides improvement in symptoms, long-term psychodynamic treatment also results in changes in personality structure or organization. The concept of personality organization (PO) refers to the underlying organization of structural–dynamic components of personality and has been operationalized from different theoretical perspectives in terms of (a) the developmental level of representations of self and others; (b) the capacity for reality testing and maturity of defenses; (c) the background of safety or ‘felt security`; as well as, more recently, (d) the capacity for mentalization operationalized both in terms of reflective functioning and the Bion-Grid Scale. Although changes in PO are supposed to constitute a core mechanism of change in psychodynamic treatment for PD, today only a handful of studies have empirically investigated this assumption. Based on this, the first aim of this study was to replicate and extend existing research in this area by simultaneously assessing changes in PO using four different measures reflecting different aspects of PO, namely (a) the developmental level of representations of self and others as measured with the DR- S; (b) mentalization as assessed by the Reflective Functioning Scale (RFS) and the GRID; and finally, (c) levels of felt safety as measured with the Felt Safety Scale (FSS). All scales are scored on the Object Relations Inventory (ORI). The second aim of this study was to investigate whether the 44 patients in a psychoanalytic hospitalization-based treatment for PD show different trajectories of change in PO and whether these different trajectories were associated with different pre-treatment characteristics. In particular, several studies have provided considerable evidence suggesting that anaclitic and introjective personality features (Blatt, 2004) are associated not only with different responses to treatments but also with different changes in terms of PO. In this context, Blatt (2004, 2008) has proposed that anaclitic patients are characterized by a distorted preoccupation with relationship issues, such as trust and intimacy, at the expense of self-development, as for instance expressed in dependent, histrionic and borderline personality features. Introjective patients are primarily preoccupied with intense and distorted attempts at establishing and maintaining a sense of self, including feelings of autonomy, self-control and self-worth, at the expense of developing interpersonal relationships, as in schizoid, schizotypic, paranoid, narcissistic, antisocial, avoidant, self- defeating and obsessive–compulsive PDs and features.
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