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Yıl:2012; Cilt: 3; Sayı: 1>> Özet
TAM METİN
Psikiyatri Hemşireliği Dergisi; 2012;3(1):30-37
Borderline kişilik bozukluğu gösteren hastalarda psikodinamik grup psikoterapi sürecinin nesne ilişkileri üzerine etkileri
NE Öğünç, N Eren
İÜ İstanbul Tıp Fakültesi, İstanbul
AMAÇ: Borderline kişilik bozukluğu (BKB) tanısı alan hastaların psikoterapi süreçleri ve nesne
ilişkileri ile ilgili bulguların klinik gözlemlere dayandığı ve bunların varlığını kanıtlamak üzere
etkin ve sistematik psikolojik test/ölçek yöntemlerinin geliştirilmesi ve uygulanmasına ihtiyaç
duyulduğu literatürde vurgulanmaktadır. Bu çalışmada, borderline kişilik bozukluğu (BKB)
tanısı alan hastalarda psikodinamik grup psikoterapisinin, nesne ilişkileri üzerine etkilerinin
araştırılması amaçlanmıştır.

YÖNTEMLER: Çalışma, İÜ İTF Psikiyatri AD Sosyal Psikiyatri Servis'inde (SPS) tedavi için kabul edilen, DSM-IV tanı ölçütlerine göre BKB tanısı alan 12 hasta ile ön-test/son-test, kontrol gruplu desende, tek kör deneysel bir çalışma olarak gerçekleştirilmiştir. Hastalar, SPS'de psikoterapi için değerlendirilmesi bitenler arasından seçilmiş; başvuru sırasına göre ilk 6 kişi grup psikoterapisine alınarak deney grubunu ve bekleme listesinden sosyo-demografik özellikleri tam olarak eşleştirilmiş 6 kişi de kontrol grubunu oluşturmuştur. Deney grubu hastaları 90 dakikalık 30 oturumdan oluşan -yaklaşık 8 aylık- psikodinamik grup terapisine katılmışlar, kontrol grubu hastaları herhangi bir psikoterapi almamış, her iki grup da benzer biçimde bir psikiyatri asistanı ile 15-30 gün aralarla 15-20 dakikalık rutin poliklinik görüşmelerini sürdürmüşlerdir. Psikoterapiye katılmayan bir klinik psikolog tarafından hem kontrol hem de deney grubu üyelerine, grup psikorterapisine başlamadan önce ve grup psikoterapisinin sonunda, Blatt ve ark. tarafından geliştirilen Rorschach Nesne Kavramı Ölçeği, birebir görüşme yoluyla uygulanmıştır. Elde edilen veriler ön test ve son test sonuçları arasında istatistiksel olarak incelenmiştir.
BULGULAR: Grup terapisine katılan hastaların, grup öncesi ve sonrası ?bütünleşme? sonuçlarında; ?nesne ve eylem belirgin olmayan bütünleşmesi? ve ?sözel olarak ifade etme derecesi'nde anlamlı düzeyde bir artış (p<0.05), 'e ylemin motivasyonu? değişkeninde anlamlı (p<0.05) düzeyde bir azalma saptanmıştır. 'a yırt etme? sonuçlarında ise, (H) ?kısmi insan? yanıtlarında istatiksel olarak (p<0.01) anlamlı bir azalma, H ?bütün insan? yanıtlarında ise belirgin bir artış bulunmuştur.
SONUÇ: Grup psikoterapisi uygulanan BKB hastalarında Rorschach Nesne Kavramı Ölçeği ile yapılan gelişimsel analiz sonucunda grup öncesine ve kontrol grubuna göre terapi sürecinin nesne ilişkileri ve tasarımları üzerinde etkili olduğu görülmüştür.
Effects of the psychodynamic group psychotherapy process on object relations for patients with borderline personality disorder
OBJECTIVE: It has been emphasized in literature that findings about the psychotherapy processes and objects relations of patients with a diagnosis of borderline personality disorder (BPD) rely on clinical observations and there is a need to develop and apply effective and systematic psychological test/scale methods in order to prove those findings. In this study, it has been aimed to investigate the effects of group psychotherapy on object relations of patients with a diagnosis of BPD.
METHODS: The study has been carried out single-blind with control group experimental study pre-test/post-test with 12 patients diagnosed with BPD according to DSM-IV criteria and approved for treatment at Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Social Psychiatry Service (SPS). The patients were selected from the list of patients that were evaluated for psychotherapy in SPS. The first 6 patients that applied for treatment were assigned for group psychotherapy and compromised the experimental group and 6 people from the waiting list who were matched for socio-demographic properties were selected for the control group. Patients in the experimental group attended group psychotherapy for 30 sessions lasting 90 minutes for each session during approximately 8 [month]s. The patients in the control group did not get any psychotherapy, but both groups continued their routine follow up psychiatric meetings with a psychiatry assistant lasting 15-20 minutes, at every 15 to 30 days. Rorschach Concept of the Object Scale, which was developed by Blatt et al. has been applied with face to face interviews to both control and experimental groups by a clinical psychologist who was not involved in the psychotherapy process before and after the overall group psychotherapy procedure. The findings have been analysed between two groups statistically.
RESULTS: Compared to the results before psychotherapy commenced, ?integration?, ?nonspecific fusion of object and action? and ?degree of articulation? scores of the patients involved in group psychotherapy had increased in a statistically significant level after the termination of therapy (p<0.05) and there was a statistically significant decrease in the ?motivation of action? variable (p<0.05). Among the ?differentiation? results, there was a high level of statistically significant decrease in (H) ?quasi human? responses (p<0.01) and a significant increase in H ?human? responses.
CONCLUSION: The developmental analysis carried out with Rorschach Concept of the Object Scale, displays the fact that group psychotherapy process is effective on object relations and concepts for patients with BPD.

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