Sınır kişilik bozukluğu hastalarının bireysel psikodinamik sanat psikoterapisi sürecindeki değişimlerinin incelenmesi

Amaç: Bu çalışmada sınır kişilik bozukluğu (SKB) hastalarıyla yürütülen bireysel psikodinamik sanat psikoterapisi sürecindeki değişimlerin incelenmesi amaçlanmıştır. Yöntem: Çalışma, boylamsal bir araştırma modelinde tasar- lanmıştır. Bu çalışmada, SKB olan 11 hastanın bireysel psikodinamik sanat psikoterapi sürecinde meydana gelen değişimler incelenmiştir. Psikoterapiye en az dört yıl katılan hastalar alınmıştır. Psikoterapi, psikodinamik sanat psikoterapisi konusunda deneyimli bir psikoterapist tarafından yapılmış, nesne ilişkileri modeli temelinde psikodina- mik bireysel sanat psikoterapi yaklaşımı kullanılmıştır. Hastalarla psikoterapi görüşmelerinin sıklığı haftada 1-3 arası değişmiş, bir psikiyatrist tarafından belli aralıklarla tıbbi kontrol yapılmıştır. Psikoterapi süreci boyunca psikote- rapiste süpervizyon sağlanmıştır. Psikoterapi sürecinde, hastaların davranışları, gündeme getirdikleri konular, seansta yaşadıkları ve paylaştıkları duygular, psikoterapistin davranışları Psikoterapi Süreci Gözlem Listesi aracı- lığıyla kaydedilmiştir. Verilerin analizinde SPSS 22.0 paket programı kullanılmıştır. Sonuçlar: Hastaların 6-8 yıldır psikoterapilerini sürdürdükleri, psikoterapi süreci boyunca saldırgan ve uyumsuz davranışlarında, duygularında, gündeme getirdikleri konularda, hastaların ve terapistin tutumlarında değişim olduğu görülmüştür. Psikoterapinin başlangıcında kendilerine ve başkalarına yönelik yıkıcı, saldırgan, uyumsuz davranışların ve yoğun acı, üzüntü, kaygı, yetersizlik, suçluluk gibi duyguların şiddetli olduğu; üçüncü yılda odağın psikoterapi çerçevesine ve terapiste yöneldiği, saldırganlık ve kavga çıkarma davranışlarının azalmasına karşın, terapiye ve terapiste yönelik psikoterapi sınırlarını zorlayan davranışlarda artış olduğu görülmüştür. Bununla birlikte hastaların psikoterapiye devam ettikleri, belirtilerin ancak sonlanma döneminde başlangıca göre istatistiksel olarak anlamlı derecede azaldığı görülmüştür. Tartışma: Bu çalışmanın vurguladığı en önemli sonuç, KB’lerin psikoterapisinin sessiz ve sakin seyretmediği, yoğun duygusal dalgalanmaların terapist ve hastayı uçlaştırabildiği, uzun süreli psikoterapi sürecinde hem hastanın, hem de terapistin davranışlarının birlikte değiştiği ve terapi ilişkisine odaklanmanın önemli olduğunu ortaya çıkarmasıdır. (Anadolu Psikiyatri Derg 2019; 20(4):350-359)

Examination of changes in psychodynamic art psychotherapy process of patients with borderline personality disorder

Objective: The aim of this study was to examine of changes in the individual psychodynamic art therapy process of patients with borderline personality disorder. Method: The study was designed in the longitudinal survey model. In this study, the changes in psychodynamic psychotherapy process of 11 patients with BPD were examined. Pa- tients who participated in psychotherapy for at least 4 years were included in the study. The psychotherapy process based on object relations model which is conducted with individual art psychotherapy approach was used by a psychotherapist experienced in psychodynamic art psychotherapy. The frequency of psychotherapy interviews with patients changed between 1 and 3 times a week, and a psychiatrist periodically examined the patient. Supervision was provided during the psychotherapy process. In the psychotherapy process, the behaviors of the patients, the issues they raised, the feelings they experienced and shared during the session, and the attitude of the psychother- apist were recorded through the Psychotherapy Process Observation List. SPSS 22.0 package program is used for data analysis. Results: In this study, it was observed that patients continued their psychotherapy for 6-8 years, and it is seen that there is a change in the aggressive and maladaptive behaviors of the patients, the emotions, the sub- jects, the patients and the therapist's attitudes during the psychotherapy process. At the beginning of psychother- apy, aggressive, self-mutilative and disrupting behaviors were observed. Despite the decrease in aggression and fighting behavior in the third year, there was an increase in behaviors that disrupt the therapy limits and forced the therapy. The therapist was also worried about desperation and losing control. On the other hand, it is observed statistically that the patients continue to have psychotherapy and the symptoms have decreased significantly in the end of the period. Discussion: The most important result emphasized by this study is that the psychotherapy of BPs is not silent and calm, intense emotional fluctuations can center the therapist and the patient, and that both the patient and the therapist's behavior change together in the long term psychotherapy process and it is important to focus on the therapy relationship in terms of both sides. (Anatolian Journal of Psychiatry 2019; 20(4):350-359)

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