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UEL Research Repository University of East London Professional Doctorate in Clinical Psychology Assessment Proforma Please read the following candidate’s declaration, and tick the adjacent boxes to confirm that you have complied with each statement. Then complete the cover sheet below in full. Failing to do will result in your assessment being returned to you for resubmission. Please raise any queries regarding this form with your academic tutor well in advance of submission. CANDIDATE’S DECLARATION I confirm that no part of this submitted material, except where clearly quoted and referenced, has been copied from material belonging to any other person (e.g., from Tick to confirm a book, article, lecture handout, web site, or another candidate). I am aware that it is a breach of university regulations to copy the work of another without clear acknowledgement, and that attempting to do so will render me liable to disciplinary √ proceedings. I confirm that the word count cited below is accurate, and within the limit allowed for Tick to confirm this type of assessment. The count includes all words in the body of text, diagrams, Tables and footnotes (though not the contents page, references or appendices). I have presented the assessed work with page margins, line spacing, font size and √ page numbers as required in the relevant section of the handbook and module guide. COVER SHEET UEL STUDENT NUMBER U1138198 MODULE CODE WORK TO BE ASSESSED THESIS (e.g., Year 1 Essay, Practical Report 3, SRR) SUBMISSION DATE 09/05/2014 WORD COUNT 23413 1 A study of the relationship between transliminality and interpersonal difficulties: Is the severity of interpersonal difficulties related to sensitivity to unconscious psychological material? Doctorate in Clinical Psychology Thesis Submission date: 12th May 2014 Stephen Rock Student Number: 1138198 2 Table of Contents Page number ACKNOWLEDGMENTS 6 ABSTRACT 7-8 1. BACKGROUND AND INTRODUCTION 8-30 1.1. Literature review 8-23 1.1.1. Context of this review 8-10 1.1.2. Scope of review 10 1.1.3. Search strategy 10 1.1.3.1 Transliminality search strategy 11 1.1.3.2. Interpersonal difficulties search strategy 11 1.1.3.3. Psychodynamic theories of interpersonal difficulties search 11 strategy 1.1.3.4. Mentalization search strategy 11 1.1.4. Transliminality literature review 12-25 1.1.4.1. Consciousness 12-13 1.1.4.2. The unconscious and preconscious 13-14 1.1.4.3. Evidence from psychology and neuroscience 14-15 1.1.4.4. The development of a measure of transliminality 15-16 1.1.4.5. Qualitative studies of transliminality 17-18 1.1.5. Interpersonal difficulties literature review 18-23 1.1.5.1. Personality disorders 19-21 1.1.5.2. Defining interpersonal difficulties 21-23 1.1.6. Psychodynamic theories of interpersonal difficulties literature 23-25 review 1.2. Exploring the relationship between mentalization and 25-27 transliminality 1.2.1. Mentalization, attachment hyperactivity and IPD 26-27 1.2.2. Mentalization, transliminality and IPD 27 1.3. A hypothesised model of IPD 28 1.3.1. Transliminality and the mentalization model 28-30 1.3.2. Transliminality and psychoanalytic theories of IPD 30 2. RESEARCH QUESTIONS AND HYPOTHESES 30-32 2.1. Research question 1: Is transliminality related to IPD and 30 what is the nature of this relationship? 2.1.1. Hypothesis 1: There will be a U-shaped correlation between 30 IPD and transliminality 2.2. Research question 2: Does transliminality mediate the 31 effects of mentalization and attachment hyperactivation on IPD? 2.2.1. Hypothesis 2: Attachment hyperactivity will positively correlate 31 with IPD. 2.2.2. Hypothesis 3: Mentalization will negatively correlate with IPD. 31 2.2.3. Hypothesis 4: Transliminality with positively correlate with 31 mentalization 3 2.2.4. Hypothesis 5: Transliminality will positively correlate with 31 attachment hyperactivity 2.2.5. Hypothesis 6: Transliminality will mediate the association 32 between mentalization and IPD. 2.2.6. Hypothesis 7: Transliminality will mediate the positive 32 correlation between attachment hyperactivity and IPD. 3. METHOD 33-49 3.1. Rationale for design 33-34 3.2. Epistemology 34 3.3. Participants and Criteria for Selection 34-36 3.3.1. Clinical sample 34-35 3.3.2. Non-clinical sample 35-36 3.4. Sample size and power calculations 36 3.4.1. Power calculations 36 3.5. Measures 37-44 3.5.1. Transliminality - The Revised Transliminality Scale (RTS) 37-39 3.5.2. Interpersonal difficulties - Inventory of Interpersonal Problems 39-40 32 (IIP-32) 3.5.3. Attachment hyperactivity: Experiences in Close Relationships 40-42 Questionnaire (ECR-R) 3.5.4. Mentalization - Reading the Mind in the Eyes (RME) 42-44 3.5.5. Demographic information 44 3.5.6. Psychometric properties of the questionnaires 44 3.6. Procedure 44 3.6.1. Clinical sample 44-45 3.6.2. Non-clinical sample 45 3.6.3. Questionnaire order effects 46 3.7. Statistical analysis 47 3.8. Ethical Aspects of the research 48-49 4. RESULTS 49-70 4.1. Non-clinical sample 49-65 4.1.1 Sample characteristics 49-51 4.1.2 Descriptive statistics and norm comparisons - study measures 51-52 4.1.3 Hypothesis testing 52-65 4.1.3.1 Research question 1 – Exploring the relationship between 52-53 transliminality and interpersonal difficulties 4.1.3.2. Research question 2: Does transliminality mediate the effects 53-58 of mentalization and attachment hyperactivation on IPD? 4.1.3.3. Additional hypothesis: Each predictor variable will be related 58-65 to different aspects IPD 4.2. Clinical sample 65-70 4.2.1 Sample characteristics 65-66 4.2.2 Descriptive statistics and norm comparisons - study measures 66-67 4.2.3. Hypothesis testing 67-70 4.2.3.1. Research question 1 – Exploring the relationship between 67-70 transliminality and interpersonal difficulties 4.2.3.2. Summary of clinical sample results 70 4 5. DISCUSSION 71-92 5.1. Summary of findings 71-73 5.1.1. Non-clinical sample 71-73 5.1.1.1. Evaluating the data in relation to the hypothesised model 71 5.1.1.2. Additional analysis of IIP-32 sub-scales 72 5.1.2. Clinical sample 73 5.2. Relating the findings to existing theory 73-85 5.2.1. What the findings reveal about the mentalization-based model 73-78 of IPD 5.2.1.1 The ‘loose coupling’ of mentalization and attachment 73-76 hyperactivation 5.2.1.2. Why was transliminality not related to mentalization and 76-78 attachment hyperactivity? 5.2.3. Explaining the positive relationship between transliminality and 78-85 IPD 5.2.3.1. Transliminality and thick and thin-skinned narcissistic states 78-79 5.2.3.2. Transliminality and Kernberg’s continuum 79-80 5.2.3.3. The role of transliminality in adaptive and pathological 80-85 mechanisms 5.3. Clinical Implications 85-88 5.4. Further research 88-90 5.5. Methodological limitations 90-92 5.6. Conclusion 92 REFERENCES 92-112 APPENDICES 113-134 Appendix A: Invitation to participate letter (clinical sample) 113 Appendix B: Debriefing sheet 114 Appendix C: Invitation to participate (non-clinical sample) 115 Appendix D: NHS ethical approval confirmation letter 116-119 Appendix E: University of East London ethical approval confirmation 120-122 letter Appendix F: Participant Information Sheet (clinical sample) 124-125 Appendix G: Participant Consent Form (clinical sample) 125 Appendix H: Participant Consent Form (non-clinical) 126 Appendix I: NHS Research and Development Approval (Site 1) 127-129 Appendix J: NHS Participant Identification Centre (PIC) approval 130 letter Appendix K. UEL ethical approval of amendments relating to the 131-134 recruitment of the non-clinical sample 5 Acknowledgements I would like to thank James Walsh and Martyn Baker for their enthusiasm and excellent supervisory support. I would also like to thank Brian Solts for his support and assistance with recruiting participants from the NHS services. Most importantly, I would like to express my gratitude to all of the people who gave up their time to participate in this study. 6 ABSTRACT Despite a growing literature supporting the view of a dynamic unconscious, there have been few attempts to empirically investigate the role of unconscious processes in relation to existing models of psychopathology. In this study, the concept of transliminality (defined as ‘a hypothesised tendency for psychological material (trans) thresholds (limines) into or out of consciousness’, Thalbourne & Houran, 2000, p. 853) and a standardised self-report measure of this construct were used to explore relationships between unconscious processes and interpersonal difficulties. Transliminality and two of the central components of the mentalization-based model of interpersonal difficulties – attachment hyperactivity and mentalization, were examined. The mentalization model was seen as a fitting context for this investigation given that mentalization draws on attachment theory, psychoanalytic principles and makes reference to unconscious processes. Using standardised self-report measures this study attempted to answer two research questions. Firstly, is transliminality related to interpersonal difficulties and what is the nature of this relationship? Secondly, does transliminality mediate the effects of mentalization and attachment hyperactivation on interpersonal difficulties? These questions were investigated using a clinical sample recruited from two NHS specialist adult psychological therapies services (N = 16) receiving referrals for those between the age of 18 to 65 and a non-clinical sample (N = 60). The data from the non-clinical sample revealed that transliminality, mentalization and attachment hyperactivity were all predictors of interpersonal difficulties. The variance uniquely accounted for by each predictor and the lack of relationships between them, was seen as a reflection of these constructs representing distinct psychological processes that contribute to interpersonal difficulties.
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