پناهگاه‌های روانی در افراد مبتلا به اختلال شخصیت خوشه C؛ یک مطالعه موردی

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری، گروه روان‌شناسی، دانشگاه خوارزمی، تهران، ایران

2 استاد، گروه روان‌شناسی، دانشگاه خوارزمی، تهران، ایران

3 استاد‌یار، گروه راهنمایی و مشاوره، دانشگاه خوارزمی، تهران، ایران

چکیده

مقدمه: پناهگاه روانی شامل شبکه‌ای از روابط ابژه‌ای آسیب‌ شناختی و منظومه‌ای از دفاع‌هاست که در خدمت محافظت از بیمار در برابر مجموعه‌ای از اضطراب‌ها عمل می‌کند. هدف از انجام این پژوهش ارزیابی و فهم تظاهرات رفتاری و نشانه‌های متناظر با پناهگاه‌های روانی در افراد دارای اختلال شخصیت خوشه c بود.
روش: پژوهش حاضر به روش کیفی و مبتنی بر مطالعه موردی با رویکرد پدیدارشناختی - هرمنوتیکی بود. اطلاعات از طریق مصاحبه‌های نیمه‌ساختاریافته با سه دانشجوی مبتلا به اختلال شخصیت خوشه c جمع‌آوری شد. نمونه‌گیری به روش هدفمند بود و داده‌ها براساس تحلیل تفسیری پدیدارشناختی (IPA) مورد تحلیل قرار گرفت.
یافته ­ها: مفاهیم شناسایی شده از مصاحبه‌ها در نُه مضمون خوشه‌بندی شد که شکل‌دهنده دو مضمون بالاتر پناهگاه‌های روانی است. بر مبنای الگوهای به‌دست آمده و تبیین ساختاری، شکل اختصاصی پناهگاه روانی برای هر یک از مشارکت‌کنندگان تشریح شد: پناهگاه روانی بر اساس شرم و تحقیر ناشی از ابژه مشاهده‌گر، پناهگاه روانی بر اساس شکایت و تظلم، و پناهگاه روانی بر اساس خشم و شکایت و کشمکش بر سر قدرت.
نتیجه ­گیری: نتایج به‌دست آمده نشان می‌دهد در هر سه اختلال شخصیت خوشه c، سازمان آسیب‌شناختی با ماهیت و کیفیت مشابه اما با تظاهرات نشانه‌ای متمایز برای هر اختلال شخصیت در شکل پناهگاه روانی نمود یافته است. توجه روان‌درمان‌گران به ماهیت و کارکرد پناهگاه‌های روانی و نقش آن در ایجاد بن‌بست درمانی و وقفه تحولی می‌تواند دریچه‌ای باشد برای فهم بهتر موضع بیمار و خود درمانگر و غنای روان‌درمانی.

کلیدواژه‌ها


عنوان مقاله [English]

Psychic Retreats in Cluster C Personality Disordered Individuals: a qualitative case study

نویسندگان [English]

  • Hasan Hadinezhad 1
  • Mohammad-Naghi Farahani 2
  • Azizollah Tajikesmaeili 3
1 PhD Student, Department of Psychology, University of Kharazmi
2 PhD, Professor, Department of Psychology, University of Kharazmi
3 PhD, Associate professor, Department of Counseling, University of Kharazmi
چکیده [English]

Introduction: Psychic retreat consists of a network of pathological object relationships and a system of defenses that serve to protect the patient against a range of anxieties. The aim of this study was to evaluate and understand the behavioral manifestations and symptoms corresponding to psychic retreats in individuals with cluster C personality disorder.
Method: The present study was a qualitative method based on a case study with a phenomenological-hermeneutic approach. Data were collected through semi-structured interviews with three students with cluster c personality disorder. Sampling was purposive and the data were analyzed based on phenomenological interpretive analysis (IPA).
Results: The concepts identified from the interviews were clustered in nine sub-themes, which form the two main themes of psychic retreats. Based on the obtained patterns and structural explanation, the specific form of the retreat was explained to each participant: a psychic retreat based on shame and humiliation caused by the observer object, a psychic retreat based on grievances, and a psychic retreat based on anger and grievance and the struggle for power.
Conclusion: The results show that in all three personality disorders of cluster c, the pathological organization with the same nature and quality but with distinct symptom manifestations for each personality disorder has appeared in the form of psychic retreat. Psychotherapists' attention of the nature and function of psychic retreats and its role in creating therapeutic impasse and developmental interruption can be a window to better understand the position of the patient and the therapist and the richness of psychotherapy.

کلیدواژه‌ها [English]

  • psychic retreat
  • personality disorder
  • pathological organization
  • object relationships
  • defense mechanism
  1. Grotstein G. Endopsychic structures, psychic retreats, and "fantasying": the pathological "third area" of the psyche. In Fairbairn and relational theory. London: Karnak; 2002.
  2. Steiner J. Psychic Retreats: Pathological Organisations of the Personality in Psychotic, Neurotic, and Borderline Patients. London: Routledge; 1993.
  3. Carvalho R. Psychic retreats revisited: Binding primitive destructiveness or securing an object? A matter of emphasis? British Journal of Psychotherapy 2002;19: 153-71.
  4. Segal H. Some clinical implications of Melanie Klein’s work: emergence from narcissism. International Journal of Psycho-Analysis. 1983;64: 269-76.
  5. Steiner J. ‘The interplay between pathological organisations and the paranoid-schizoid and depressive positions. Spillius E, editor. London New York: Routledge; 1987.
  6. Astor J. Michael Fordham, Innovations in analytical psychology. New York: Taylor & Francis; 2001.
  7. Shipton G. Working with eating disorders: a psychoanalytic approach. New York: Palgrave Macmillan; 2004.
  8. Lingiardy, V, McWilliams N. Psychodynamic Diagnostic Manual: PMD-2. 2 ed. New York: The Guilford Press; 2017.
  9. Kernberg OF, Caligor E. A psychoanalytic theory of personality disorders, in Major Theories of Personality Disorder. 2 ed. New York: Guilford; 2005.
  10. Svrakic D, Divac-Jovanovic M, Azhar N. An Integrative model and dynamic nosology of personality disorder: Part 2: Symptom-based pharmacotherapy. Psychiatria Danubina. 2019;31(1):2-17.
  11. Fonagy P. Attachment and borderline personality disorder. Journal of the American Psychoanalytic Association. 2000;48(4):1129-46
  12. Kernberg OF CE. A psychoanalytic theory of personality disorders, in Major Theories of Personality Disorder. 2th ed. New York: Guilford; 2005.
  13. Lampe L, Malhi GS. Avoidant personality disorder: Current insights. Psychol Res Behav Manag. 2018;11: 55-66.
  14. Millon T, Grossman G, Millon C, Meagher S, Ramnath R. personality disorders in modern life. 2 ed. New Jersey: John Wiley & Sons, Inc.; 2004.
  15. Kupeer D, Regier D. DSM-5 Task Force: Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC.
  16. Huprich SK. Malignant self-regard: a self-structure enhancing the understanding of masochistic, depressive, and vulnerably narcissistic personalities. Harv Rev Psychiatry. 2014;22(5):295-305.
  17. Strauss L. Comparing a narcissistic and an autistic retreat: ‘Looking through or at the window’. Int J Psychoanal. 2012;93: 97-116.
  18. Carvalho LF, Reis AM, Pianowski G. Investigating correlations between defence mechanisms and pathological personality characteristics. Revista Colombian De Psiquiatria. 2019;48(4):232-43.
  19. Giuseppe MD, Gennaro A, Lingiardi V, Perry JC. The Role of Defense Mechanisms in Emerging Personality Disorders in Clinical Adolescents. Psychiatry: Interpersonal and Biological Processes. 2019;82(2):128-42.
  20. Granieri A, La Marca L, Mannino G, Giunta S, Guglielmucci F, Schimmenti A. The Relationship between Defense Patterns and DSM-5 Maladaptive Personality Domains. Front Psychol 2017;8(2):1-12.
  21. Kim HG, Jeong J, Cha Y, Choi JH, Cheon EJ, Lee JY, et al. Differences of Defense Mechanisms and Psychological Characteristics between the Patients with Cluster B and C Personality Disorders of DSM-IV: Implication for Theory of Borderline Personality Organization. Korean Association of Psychoanalysis. 2014;25(1):13-23.
  22. Bowins B. Personality Disorders: A Dimensional Defense Mechanism Approach. Ame J Psychother. 2010;64(2):153-69.
  23. Berman SM, McCann JT. Defense mechanisms and personality disorders: an empirical test of Millon's theory. J Pers Assess. 1995;64(1):132-44.
  24. Vaillant GE. Ego Mechanisms of Defense and Personality Psychopathology. Journal of Abnormal Psychology. 1994;103(1):44-50.
  25. Waska R. Modern Kleinian Couples Therapy with Emphasis on Psychic Retreats and Pathological Organizations. American journal of psychotherapy. 2014;65(2):149-65.
  26. Kadish Y. Pathological Organizations And Psychic Retreats In Eating Disorders. Psychoanalytic Review. 2012;99(2):227-52.
  27. Weiß H. Suicidality As An Expression Of ‘Psychic Retreats’: Some Clinical And Theoretical Aspects. Psychoanalytic Psychotherapy. 2009;23(2):99-108
  28. Fukumoto O. Personality disorders and psychoanalytic psychotherapy. Seishin Shinkeigaku Zasshi. 2011;113(2):206-13
  29. Greenwood D, Loewenthal D. The Use of ‘Case Study’ in Psychotherapeutic Research and Education. Psychoanalytic Psychotherapy 2005;19,35-47
  30. Dreher A. Foundations for Conceptual Research in Psychoanalysis. London: Karnac; 2000.
  31. First MB, Williams JBW, S. BL, Spitzer RL. Washington, DC: American Psychiatric Association. 2016.
  32. Clarkin J, Caligor E, Stern B, Kernberg OF. The Structured Interview for Personality Organization-Revised (STIPO-R). 2016.
  33. George, C., et al. (1985). The Adult Attachment Interview. Berkeley.
  34. Smith JA, Flowers P, Larkin M. Interpretative Phenomenological Analysis. London: SAGE; 2009.
  35. Yin RK. Case Study Research and Applications. 6 ed. London: SAGE; 2018.
  36. Summers F. Transcending the Self: An Object Relations Model of of Psychoanalytic Therapy. London and New York: Routledge; 1999. [Persian]
  37. Steiner J. Seeing and Being Seen, Emerging from a Psychic Retreat. London, New York: Routledge; 2011.
  38. Grotstein J. But At The Same Time And On Another Level. London: Karnak; 2009.
  39. Van-Manen M. Phenomenology of Practice: Meaning-Giving Methods in Phenomenological Research and Writing. London, New York: Routledge; 2014.
  40. Guba EG, Lincoln YS. Competing Paradigms in qualitative research. In N.K. Denzin & Y.S. Lincoln (Eds.), Handbook of Qualitative Research. London: SAGE; 1994.