OBJECT RELATIONS DEVELOPMENT AND PSYCHOTHERAPY DROPOUT IN BORDERLINE OUTPATIENTS

Using Rorschach object relations measures, we sought to identify patte rns of object representations in borderline outpatients that would dis tinguish those at risk for premature termination from those likely to continue in expressive psychodynamic psychotherapy. In this explorator y pilot study, patients who dropped out of treatment in the Cornell Bo rderline Psychotherapy Research Project (Kernberg, Selzer, Koenigsberg , Carr, & Appelbaum, 1989; Yeomans, Selzer, & Clarkin, 1993; Yeomans e t al., 1994) showed a predominance of narcissistic themes in their Ror schach responses at the outset of treatment, as scored by the Rorschac h Separation-Individuation Scale (S-I Scale; Coonerty, Diamond, Kaslow , & Blatt, 1987). Whereas those who continued in treatment were charac terized by a relatively even ratio of narcissism to higher-level rappr ochement themes on the S-I Scale, psychotherapy dropouts produced almo st 4 times as many narcissism as rapprochement themes. Moreover, subje cts who completed treatment were typified by a relatively even distrib ution of scores across all separation-individuation subphases, in cont rast to the predominance of narcissism themes in the records of dropou ts. These Rorschach findings were reflected in ratings of psychotherap y transcripts. Results are discussed in light of object relations theo ry.