Mentalization And Personality Organization In Heroin Addicted Patients: A Narrative Analysis
Abstract
The relationship between the dimensions of personality organization and the quality of mentalization is an important object of study in contemporary psychodynamic theory and it also contributes to the understanding of heroin addiction with comorbid personality disorders. The current study aims to assess levels of personality organization and its main domains (Identity, Object relations, Defense Mechanisms) in patients with opiate addiction, as well as the quality of affect mentalization and possible connections between them. In order to do so we have adopted quantitative text-analysis method of affect mentalization to parts of а interview, trying to show that the language which participants use could be in itself a psychodiagnostic means. A group of 30 heroin addicted patients in a methadone treatment programme and a control group of 30 healthy participants were assessed with the Structured Interview of Personality Organization (STIPO), VEA (Verbal Elaboration of Affect Scale) and The Measure of Affect Contents (MAC). Results show significant differences between the two groups, concerning all dimensions of personality organization as well as some core areas of affect mentalization. The capacity for affect mentalization is significantly correlated to the level of personality organization. The results are discussed from the point of view of the adopted theoretical models and the implications for psychotherapeutic work in the bio-psycho-social model.
References
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de Mijolla, A. (Ed.) (2005). International dictionary of psychoanalysis. Farmington Hills, MI: Thomson Gale.
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Garland, C. (Ed.) (1998). Understanding trauma: a psychoanalytical approach. London, UK: Duckworth.
Glover, E. (1932). On the aetiology of drug-addiction. International Journal of Psycho-Analysis, 13, 298-328.
Gottschalk, L. A., & Auerbach, A. (Eds.) (1966). Methods of research in psychotherapy. New York, NY: Appleton-Century-Crofts.
Hörz, S., Clarkin, J. F., Stern, B. L., & Caligor, E. (2011). The Structured Interview of Personality Organization (STIPO): An Instrument to Assess Severity and Change of Personality Pathology. In R. A. Levy, J. S. Ablon, & H. Kächele (Eds.), Psychodynamic psychotherapy research. evidence-based practice and practice-based evidence (pp. 571-592). New York, NY: Springer.
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Jurist, E. L. (2005). Mentalized affectivity. Psychoanalytic Psychology, 22, 426-444.
Khantzian, E. (1980). Drug use as a protective system. In Lettieri, D., Sayers, M., & Pearson, H. W. (Ed.), Theories on drug abuse: selected contemporary perspectives (pp. 71-75). Rockville, MD: National Institute on Drug Abuse.
Khantzian, E. J. (2003). Understanding addictive vulnerability: an evolving psychodynamic perspective. Neuro-Psychoanalysis, 5, 5-21.
Kernberg, O. (1975). Borderline conditions and pathological narcissism, New York, NY: Jason Aronson
Kernberg, O. (2003). The management of affect storms in the psychoanalytic psychotherapy of borderline patients. Journal of the American Psychoanalytic Association, 51, 517-455.
Krystal, H. (1974). The genetic development of affects and affect regression. Annual of Psychoanalysis, 2, 98-126.
Krystal, H. (1975). Affect tolerance. Annual of Psychoanalysis, 3, 179-219.
Lecours, S. (2002). Manuel d'identification des contenus affectifs (MAC). Unpublished manuscript.
Laffal, J. (1965). Pathological and normal language. New York, NY: Atherton Press
Lecours, S. (2013). Verbal elaboration of affect scale scoring manual (version 7). Unpublished manuscript.
Lecours, S. & Bouchard, M (1997). Dimensions of mentalization: outlining levels of psychic transformation. International Journal of Psychoanalysis, 78, 855-875.
Lecours, S., Bouchard, M.A., St-Amand, P., & Perry, J. C. (2000). Assessing verbal elaboration of affect in psychotherapy: A preliminary report and single case study. Psychotherapy Research, 10, 47-56.
Lecours, S. & Bouchard, M. (2011). Verbal elaboration of distinct affect categories and BPD Symptoms. Psychology and Psychotherapy: Theory, Research and Practice, 84, 26-41.
Lecours, S., Sanlian, N., & Bouchard, M.-A. (2007). Assessing verbal elaboration of affect in clinical interviews: Exploring sex differences. Bulletin of the Menninger Clinic, 71, 227247.
Luborsky, L., & Spence, D. P. (1971). Quantitative research on psychoanalytic therapy. In A. Bergin, & S. Garfield, S. (Eds.), Handbook of psychotherapy and behavior change (pp. 408-438). New York, NY: John Wiley and Sons.
Piaget, J., & Cook, M. T. (1952). The origins of intelligence in children. New York, NY: International University Press.
Marty, P. (1991). Mentalisation et psychosomatique. Paris, France: SynthélaboPiaget
Radó, S. (1928). The psychical effects of intoxication: attempt at a psycho-analyticaltheory of drug addiction. International Journal of Psycho-Analysis, 9, 301-317.
Rentrop, M., Zilker, T., Lederle, A., Birkhofer, A., Hörz, S. (2014). Psychiatric comorbidity and personality structure in patients with polyvalent addiction. Psychopathology, 47, 133-140
Sifneos, P.E. (1973). The prevalence of alexithymic characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 270-285.
Shedler, J., Mayman, M. & Manis, M. (1993). ‘The Illusion of Mental Health’. American Psychologist. 48, 1117-1131.
Stern, B., Caligor, E., Clarkin, J., Critchfield, K. L., Horz, S., MacCornack, V., Lenzenweger, M., & Kernberg, O. (2010). structured interview of personality organization (STIPO): Preliminary psychometrics in a clinical sample. Journal of Personality Assessment, 92, 35-44
Taylor, G., Bagby, R., Parker, J. (1997). The development and regulation of affects. In G. Taylor, R. Bagby, & J. Parker (Eds.), Disorders of affect regulation: alexithymia in medical and psychiatric illness (pp. 7-25). Cambridge, UK: Cambridge University Press.
Trull T. J., Sher, K.J., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality disorder and substance use disorders: a review and integration. Clinical Psychology Review, 20, 235-253.
Walter, M., Berth, H., Selinger, J., Gerhard, U., Küchenhoff, J., Frommer, J., & Dammann, G. (2009). The lack of negative affects as an indicator for identity disturbance in borderline personality disorder: A preliminary report. Psychopathology, 42, 399-404
Weinberg, E. (2006). Mentalization, affect regulation, and development of the self. Journal of the American Psychoanalytic Association, 54, 251-269.
Wieder, H. & Kaplan, E. H. (1969). Drug use in adolescents – psychodynamic meaning and pharmacogenic effect. Psychoanalytic Study of the Child, 24, 399-431.
Woody, G. E. (1977). Psychiatric aspects of opiate dependence: diagnostic and therapeutic research issues. In Blaine, J. & Julius, D. (Eds.) Psychodynamics of drug dependence (pp. 157-178). Rockville, MD: National Institute on Drug Abuse.
Wurmser, L. (1977). Mr. Pecksniff’s horse? (Psychodynamics in compulsive drug use). In Blaine, J. & Julius, D. (Eds.), Psychodynamics of drug dependence (pp. 36-72). Rockville, MD: National Institute on Drug Abuse.
Allen J. G., Fonagy P., & Bateman A. W. (2008). Mentalizing in clinical practice. Washington, DC: American Psychiatric Publishing.
Bateman, A. W. & Fonagy, P. (2004). Psychotherapy for borderline personality disorder. Mentalization based treatment. New York, NY: Oxford University Press.
Bouchard, M.-A. & Lecours, S. (2008). Contemporary approaches to mentalization in the light of Freud’s project. In Busch, F (Ed.) Mentalization: theoretical considerations, research findings, and clinical implications (pp. 103-129). New York, NY: Taylor & Francis Group.
Bouchard, M.-A., Target, M., Lecours, S., Fonagy, P., Tremblay, L.-M., & Schachter, A. (2008). Mentalization in adult attachment narratives: reflective functioning, mental states, and affect elaboration compared. Psychoanalytic Psychology, 25, 47-66.
Bucci, W., Kabasakalian, R. et al. (1992). Instructions for scoring referential activity (RA) in transcripts of spoken narrative texts. Ulm, Germany: Ulmer Textbank.
Clarkin, J., Caligor, E., Stern, B., & Kernberg, O. (2006). Structured interview of personality organization. New York, NY: Weill Medical College of Cornell University: Personality Disorders Institute.
de Mijolla, A. (Ed.) (2005). International dictionary of psychoanalysis. Farmington Hills, MI: Thomson Gale.
Doering, S., Burgmer, M., Heuft, G, Menke, D., Bäumer, B., Lübking, M., Feldman, M., Hörz, S. & Schneider, G.(2013). Reliability and validity of the German version of the Structured Interview of Personality Organization (STIPO). BMC Psychiatry, 13, 210.
Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York, NY: W.W. Norton.
Fischer-Kern, M., Buchheim, A., Hörz, S., Schuster, P., Doering, S., Kapusta, N., Taubner, S., Tmej, A., Rentrop, M., Buchheim, P., & Fonagy, P. (2010). The relationship between personality organization, reflective functioning, and psychiatric classification in borderline personality disorder. Psychoanalytic Psychology, 4, 395-409.
Fonagy, P. (2008). The mentalization-focused approach to social development. In Busch, F. (Ed.), Mentalization: theoretical considerations, research findings, and clinical implications (pp. 53-99). New York, NY: Taylor & Francis Group.
Garland, C. (Ed.) (1998). Understanding trauma: a psychoanalytical approach. London, UK: Duckworth.
Glover, E. (1932). On the aetiology of drug-addiction. International Journal of Psycho-Analysis, 13, 298-328.
Gottschalk, L. A., & Auerbach, A. (Eds.) (1966). Methods of research in psychotherapy. New York, NY: Appleton-Century-Crofts.
Hörz, S., Clarkin, J. F., Stern, B. L., & Caligor, E. (2011). The Structured Interview of Personality Organization (STIPO): An Instrument to Assess Severity and Change of Personality Pathology. In R. A. Levy, J. S. Ablon, & H. Kächele (Eds.), Psychodynamic psychotherapy research. evidence-based practice and practice-based evidence (pp. 571-592). New York, NY: Springer.
Johansen, A. B., Darnell F. J., & Franzen, E. (2013). Constructing a theory and evidence-based approach to promote and evaluate autonomy in addiction. Inquiry: an interdisciplinary journal in philosophy, 56, 539-557.
Jurist, E. L. (2005). Mentalized affectivity. Psychoanalytic Psychology, 22, 426-444.
Khantzian, E. (1980). Drug use as a protective system. In Lettieri, D., Sayers, M., & Pearson, H. W. (Ed.), Theories on drug abuse: selected contemporary perspectives (pp. 71-75). Rockville, MD: National Institute on Drug Abuse.
Khantzian, E. J. (2003). Understanding addictive vulnerability: an evolving psychodynamic perspective. Neuro-Psychoanalysis, 5, 5-21.
Kernberg, O. (1975). Borderline conditions and pathological narcissism, New York, NY: Jason Aronson
Kernberg, O. (2003). The management of affect storms in the psychoanalytic psychotherapy of borderline patients. Journal of the American Psychoanalytic Association, 51, 517-455.
Krystal, H. (1974). The genetic development of affects and affect regression. Annual of Psychoanalysis, 2, 98-126.
Krystal, H. (1975). Affect tolerance. Annual of Psychoanalysis, 3, 179-219.
Lecours, S. (2002). Manuel d'identification des contenus affectifs (MAC). Unpublished manuscript.
Laffal, J. (1965). Pathological and normal language. New York, NY: Atherton Press
Lecours, S. (2013). Verbal elaboration of affect scale scoring manual (version 7). Unpublished manuscript.
Lecours, S. & Bouchard, M (1997). Dimensions of mentalization: outlining levels of psychic transformation. International Journal of Psychoanalysis, 78, 855-875.
Lecours, S., Bouchard, M.A., St-Amand, P., & Perry, J. C. (2000). Assessing verbal elaboration of affect in psychotherapy: A preliminary report and single case study. Psychotherapy Research, 10, 47-56.
Lecours, S. & Bouchard, M. (2011). Verbal elaboration of distinct affect categories and BPD Symptoms. Psychology and Psychotherapy: Theory, Research and Practice, 84, 26-41.
Lecours, S., Sanlian, N., & Bouchard, M.-A. (2007). Assessing verbal elaboration of affect in clinical interviews: Exploring sex differences. Bulletin of the Menninger Clinic, 71, 227247.
Luborsky, L., & Spence, D. P. (1971). Quantitative research on psychoanalytic therapy. In A. Bergin, & S. Garfield, S. (Eds.), Handbook of psychotherapy and behavior change (pp. 408-438). New York, NY: John Wiley and Sons.
Piaget, J., & Cook, M. T. (1952). The origins of intelligence in children. New York, NY: International University Press.
Marty, P. (1991). Mentalisation et psychosomatique. Paris, France: SynthélaboPiaget
Radó, S. (1928). The psychical effects of intoxication: attempt at a psycho-analyticaltheory of drug addiction. International Journal of Psycho-Analysis, 9, 301-317.
Rentrop, M., Zilker, T., Lederle, A., Birkhofer, A., Hörz, S. (2014). Psychiatric comorbidity and personality structure in patients with polyvalent addiction. Psychopathology, 47, 133-140
Sifneos, P.E. (1973). The prevalence of alexithymic characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 270-285.
Shedler, J., Mayman, M. & Manis, M. (1993). ‘The Illusion of Mental Health’. American Psychologist. 48, 1117-1131.
Stern, B., Caligor, E., Clarkin, J., Critchfield, K. L., Horz, S., MacCornack, V., Lenzenweger, M., & Kernberg, O. (2010). structured interview of personality organization (STIPO): Preliminary psychometrics in a clinical sample. Journal of Personality Assessment, 92, 35-44
Taylor, G., Bagby, R., Parker, J. (1997). The development and regulation of affects. In G. Taylor, R. Bagby, & J. Parker (Eds.), Disorders of affect regulation: alexithymia in medical and psychiatric illness (pp. 7-25). Cambridge, UK: Cambridge University Press.
Trull T. J., Sher, K.J., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality disorder and substance use disorders: a review and integration. Clinical Psychology Review, 20, 235-253.
Walter, M., Berth, H., Selinger, J., Gerhard, U., Küchenhoff, J., Frommer, J., & Dammann, G. (2009). The lack of negative affects as an indicator for identity disturbance in borderline personality disorder: A preliminary report. Psychopathology, 42, 399-404
Weinberg, E. (2006). Mentalization, affect regulation, and development of the self. Journal of the American Psychoanalytic Association, 54, 251-269.
Wieder, H. & Kaplan, E. H. (1969). Drug use in adolescents – psychodynamic meaning and pharmacogenic effect. Psychoanalytic Study of the Child, 24, 399-431.
Woody, G. E. (1977). Psychiatric aspects of opiate dependence: diagnostic and therapeutic research issues. In Blaine, J. & Julius, D. (Eds.) Psychodynamics of drug dependence (pp. 157-178). Rockville, MD: National Institute on Drug Abuse.
Wurmser, L. (1977). Mr. Pecksniff’s horse? (Psychodynamics in compulsive drug use). In Blaine, J. & Julius, D. (Eds.), Psychodynamics of drug dependence (pp. 36-72). Rockville, MD: National Institute on Drug Abuse.
How to Cite
Atanassov, N., & Savov, S. (1). Mentalization And Personality Organization In Heroin Addicted Patients: A Narrative Analysis. Language and Psychoanalysis, 5(1), 14-30. https://doi.org/10.7565/landp.v5i1.1552
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