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Menopozal Süreçte Zihinselleştirme Kapasitesi ve Determinantları

Year 2023, Volume: 10 Issue: 2, 214 - 242, 31.05.2023
https://doi.org/10.31682/ayna.863586

Abstract

Bu çalışmada, premenopozal evre (PRME), postmenopozal erken evre (POMEE) ve postmenopozal geç evredeki (POMGE) kadınların zihinselleştirme kapasiteleri bakımından karşılaştırılması hedeflenmiştir. Araştırma, her grupta 10 kişi olmak üzere, toplam 30 kadınla projektif testlerden Rorschach Testi kullanılarak yürütülmüştür. Katılımcıların hangi menopozal evrede oldukları, Demografik ve Menstürel Bilgi Formunda yer alan ilgili sorulara verdikleri cevaplara göre belirlenmiştir. Rorschach testinden elde edilen verilerin analizinde, nicel ve nitel analizden oluşan, mix metod kullanılmıştır. Zihinselleştirme kapasitesini değerlendirmek için, araştırmanın amacı göz önüne alınarak, dört temel determinant belirlenmiş. Bu doğrultuda; bedensel duyumların ve cinsel dürtünün, kaybın, kadınsı ve anneliğe dair imgelerin, hoşnutsuzluk yaratan duygulanımların ve de içsel çatışmaların zihinselleştirilmesi açısından evreler arası bir farklılaşma olup olmadığı incelenmiştir. Sonuçlara göre PRME ve POMEE’de olmakla zihinselleştirme kapasitesinde gözlenen yetersizlikler arasında anlamlı bir ilişki bulunmuştur. Öte yandan POMGE ile birlikte zihinselleştirme kapasitesinde pozitif yönde bir artış görülmüştür. PRME ve POMEE arasındaki farklılaşma ise daha çok içerik analizinde ortaya çıkmıştır. Zihinselleştirme kapasitesinin alt determinantları açısından karşılaştırıldığında, cinsel dürtünün zihinselleştirilmesi bakımından en fazla POMEEG’de sorun yaşandığı görülmüştür. Kadınsı ve anneliğe dair imgelerin zihinsel olarak işlenebilmesi açısından en fazla zorlanan grubun ise PRMEG olduğu gözlenmiştir. Üreme kaybı nedeniyle yaşanan depresif duygulanımı zihinsel olarak işlemekte en fazla zorlanan grup POMEEG iken yaklaşan üreme kaybı nedeniyle yaşanan kayıp endişesini veya yaygın bedensel endişeleri zihinsel olarak işlemekte en fazla zorlanan grubun PREMEG olduğu görülmüştür. İçsel çatışmalarla yüzleşebilme ve bu çatışmaları iyi bir şekilde zihinselleştirebilme açısından ise POMGE lehine pozitif yönde anlamlı bir farklılaşma tespit edilmiştir. Determinantlar açısından evreler arası görülen farklılaşmaların nasıl yorumlanabileceği, makalenin son kısmında tartışılmıştır.

Thanks

Katılımcılarımıza çalışmamıza yapmış oldukları değerli katkılar dolayı teşekkür ederiz.

References

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  • Anzieu, D. ve Chabert, C. (2011). Projektif yöntemler (B. Kolbay, Çev.). Bağlam Yayınları. (2004)
  • Atasü, T. ve Gezer, A. (2001). Menopoz: Tanım ve terminoloji. İçinde T. Atasü, Ü. Özekici ve N. Hekim (Edl.), Menopoz-Tedavisi ve Kanser (ss. 13-26). Nobel Tıp Kitabevleri.
  • Atasü, T. ve Şahmay, S. (2001). Klimakterium ve menopoz. İçinde T. Atasü, Ü. Özekici ve N. Hekim (Edl.), Jinekoloji (ss. 657-674). Nobel Tıp Kitabevleri.
  • Auvinen-Lintunen, L., Lindgren, M., Tikkanen, R. ve Ilonen, T. (2015). Mental imagery and movement responses to the Rorschach test among young violent offenders. Rorschachiana, 36, 201-220.
  • Avis, N. E., Crawford, S. L., Greendale, G., Bromberger, J. T., Everson-Rose, S. A., Gold, E. B. ve Thurston, R. C. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 175(4), 531-539. https://doi.org/10.1001/ jamainternmed.2014.8063.
  • Bateman, A. ve Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder. World Psychiatry, 9, 11-15.
  • Baudin, M. (2005). Vieillir au féminin. Psychologie Clinique et Projective, 11, 277-288.
  • Berent-Spillson, A., Marsh, C., Persad, C., Randolph, J., Zubieta, J. K. ve Smith, Y. (2017). Metabolic and hormone influences on emotion processing during menopause. Psychoneuroendocrinology, 76, 218-225.
  • Bion, W.R. (2014). Yaşayarak öğrenmek. (T. Güvenir ve L.İ. Ekin, Çev.). Bağlam Yayınları. (1962)
  • Bromberger, J. T., Kravitz, H. M., Chang, Y., Randolph, J. F., Avis, N. E., Gold, E. B. ve Matthews, K. A. (2013). Does risk for anxiety increase during the menopausal transition? Study of women’s health across the nation. Menopause: the Journal of the North American Menopause Society, 20(5), 488-495. https://doi.org/10.1097/ gme.0b013e3182730599
  • Bryant, J., Judd, F. K. ve Hickey, M. (2012). Anxiety during the menopausal transition: A systematic review. Journal of Affective Disorders, 139, 141–148.
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  • Chou, H. F. ve Schneider, J. K. (2012). Self-regulation of menopause. Menopause: the Journal of the North American Menopause Society, 19(5), 534-540. https://doi.org/10.1097/ gme.0b013e318238f74b
  • Conklin, A. C., Malone, J. C. ve Fowler, J. T. (2012). Mentalization and the Rorschach. Rorschachiana, 33, 189–213. https://doi.org/10.1027/1192-5604/a000035
  • Çetin, M. T. (2000). Klimakterik dönemde kanama düzensizlikleri. İçinde E. Ertüngealp ve H. Seyisoğlu (Edl.), Menopoz ve Osteoporoz (ss. 28-37). Ulusal Menopoz ve Osteoporoz Derneği Yayınları.
  • Dejonghe, M., Malempré, M. ve Richelle, J. (2007). Apport du test de Rorschach dans l'évaluation diagnostique et pronostique d'adolescents auteurs d'infractions à caractère sexuel. Psychologie Clinique et Projective, 13, 347-369.
  • Dimitrijević, A., Hanak, N., Altaras Dimitrijević, A. ve Jolić Marjanović, Z. (2018). The Mentalization Scale (MentS): A self-report measure for the assessment of mentalizing capacity. Journal of Personality Assessment, 100(3), 268-280.
  • Ertem, G. (2010). Kadınların menopoz sonrası yaşam kalitelerinin incelenmesi. Uluslararası İnsan Bilimleri Dergisi, 7, 469-483.
  • Freeman, E. W, Sammel, M. D, Lin, H. ve Nelson, D. B. (2006). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archieves of General Psychiatry, 63, 375–382.
  • Frey, B. N., Hall, G. G., Attard, S., Yücel, K., Skelin, I., Steiner, M. ve Soares, C. (2010). Shift in the brain network of emotional regulation in midlife women: Is the menopausal transition the turning point? Menopause: the Journal of the North American Menopause Society, 17(4), 840-845. https://doi.org/10.1097/gme.0b013e3181df840f
  • Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y. W., Warren, F., Howard, S. ve Lowyck, B. (2016). Development and validation of a self-report measure of mentalizing: The Reflective Functioning Questionnaire. PLOS ONE, 11(7), e0158678. https://doi.org/10.1371/journal.pone.0158678
  • Fonagy, P., Target, M., Steele, H. ve Steele, M. (1998). Reflective-functioning manual, version 5.0, for application to adult attachment interviews. University College London.
  • Gori, A., Arcioni, A., Topino, E., Craparo, G. ve Lauro Grotto, R. (2021). Development of a new measure for assessing mentalizing: The multidimensional mentalizing questionnaire (MMQ). Journal of Personalized Medicine, 11(4), 305.
  • Ha, C., Sharp, C., Ensink, K., Fonagy, P. ve Cirino P. (2013). The measurement of reflective function in adolescents with and without borderline traits. Journal of Adolescence, 36, 1215–1222.
  • Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar ve Villiers, T. J. (2012). Executive summary of the stages of reproductive aging workshop+10: Addressing the unfinished agenda of staging reproductive aging. Climacteric, 15 (2), 105–114. https://doi.org/10.3109/13697137.2011.650656
  • Hunter, M. ve O'Dea I. (2001). Cognitive appraisal of the menopause: The menopause representations questionnaire. Psychology, Health & Medicine, 6(1), 65-76. https://doi.org/10.1080/713690224
  • İkiz, T. (2017). Rorschach Testi psikanalitik yorum kodlama ve uygulamalar. Bağlam Yayınları.
  • İkiz, T. T., Atak, İ. E., Düşgör, B. P. ve Zabcı, N. (2009). Rorschach kodlama kitabı 2: Yetişkin normları. Bağlam Yayınları.
  • Kandemir, F., İkiz, T. ve Sever, A. E. (2018). Postmenopozal süreçteki kadınların ruhsal işleyişlerinin projektif testler aracılığıyla değerlendirilmesi. Yansıtma; Psikopatoloji ve Projektif Testler Dergisi, 29, 65-78.
  • Kandemir, F. (2010). Post menopoz sürecindeki kadınların ruhsal yönden değerlendirilmesi [Yayımlanmamış yüksek lisans tezi]. İstanbul Üniversitesi.
  • Katznelson, H. (2014). Reflective functioning: A review. Clinical Psychology Review, 34, 107–117.
  • Kulkarni, J., Gavrilidis, E., Hudaib, A. R., Bleeker, C., Worsley, R. ve Guvich, C. (2018). Development and validation of a new rating scale for perimenopausal depression-the Meno-D. Translational Psychiatry, 8(123). https://doi.org/10.1038/s41398-018-0172-0
  • Lecours, S. ve Bouchard, M. A. (1997). Dimensions of mentalisation: Outlining levels of psychic transformation. The International Journal of Psycho-Analysis, 78, 855-875.
  • Levy, R. (2010). Adolescence: The body as a scenario for non-symbolized dramas. İçine M. Aisenstein ve E. Rappoport (Edl.), Psychosomatics Today: A Psychoanalytic Perspective (ss. 93-110). Karnac Books Ltd.
  • Marty, P. (2012). Zihinselleştirme ve psikosomatik (A. E. Sever, Çev.). Bağlam Yayınları. (1991)
  • Matthews, K. A. ve Bromberger, J. T. (2005). Does the menopausal transition affect health-related quality of life? The American Journal of Medicine, 118, 25-36.
  • Mauas, V., Kopala-Sibley, D. C. ve Zuroff, D. C. (2014). Depressive symptoms in the transition to menopause: The roles of irritability, personality vulnerability, and self-regulation. Archieves of Women’s Mental Health, 17, 279–289. https://doi.org/10.1007/s00737-014-0434-7
  • Muller, C., Kaufhold, J., Overbeck, G. ve Grabhorn, R. (2006). The importance of reflective functioning to the diagnosis of psychic structure. Psychology and Psychotherapy: Theory, Research and Practice, 79, 485–494. https://doi.org/10.1348/147608305X68048
  • Parand, N., Mosalanejad, L., Ramezanli, S. ve Ghavi, F. (2014). Menopause and crisis? Fake or real: Comprehensive search to the depth of crisis experienced: a mixed-method study. Global Journal of Health Science, 6(2). https://doi.org/10.5539/gjhs.v6n2p246
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Mentalization Capacity and Its Determinants in the Menopausal Period

Year 2023, Volume: 10 Issue: 2, 214 - 242, 31.05.2023
https://doi.org/10.31682/ayna.863586

Abstract

This study aims to compare women in premenosal stage (PrMS), early postmenopausal stage (EPoMS) and late postmenopausal stage (LPoMS) in terms of their mentalization capacity. It was conducted with a total of 30 women (10 women from each group) using the Rorschach test, one of the projective tests. The participants' menopausal stage was determined according to their answers to relevant questions in the demographic and menstrual information form. Mixed method consisting of quantitative and qualitative analysis was used for the analysis of the data obtained from the Rorschach test. In line with the objective of the research, four key determinants were selected to evaluate mentalization capacity. Accordingly, analysis was carried out to determine whether any difference existed between the three stages in terms of the mentalization of bodily excitations and sexual drive, loss, feminine and maternal images, affects of unpleasure and inner conflicts. The results indicated a significant correlation between being in PrMS or EPoMS and the deficiencies observed in mentalization capacity. With LPoMS, on the other hand, a positive change in mentalization capacity was observed. The differentiation between PrMS and EPoMS became evident especially in content analysis. When compared in terms of the subdeterminants of mentalization capacity, it was observed that most problems in the mentalization of sexual drive was experienced by the EPoMS group. It has been observed that the PrMS group experienced the most difficulty in the mental processing of images related to femininity and motherhood. While the EPoMS group had the most difficulty in mentally processing the depressive affects resulting from reproductive loss, it was observed that the PrMS group had the most difficulty in mentally processing the loss anxiety and common bodily anxieties resulting from the impending reproductive loss. A significant positive differentiation in favor of LPoMS was detected in terms of being able to face internal conflicts and mentalize these conflicts successfully. The interpretation of the determinant differentiations between stages is discussed in the last part of this article.

References

  • Allen, J. G., Fonagy, P. ve Bateman, A. W. (2013). Klinik uygulamada zihinselleştirme (S. Yelkener, Çev.). Psikoterapi Enstitüsü Eğitim Yayınları. (2008)
  • Anzieu, D. ve Chabert, C. (2011). Projektif yöntemler (B. Kolbay, Çev.). Bağlam Yayınları. (2004)
  • Atasü, T. ve Gezer, A. (2001). Menopoz: Tanım ve terminoloji. İçinde T. Atasü, Ü. Özekici ve N. Hekim (Edl.), Menopoz-Tedavisi ve Kanser (ss. 13-26). Nobel Tıp Kitabevleri.
  • Atasü, T. ve Şahmay, S. (2001). Klimakterium ve menopoz. İçinde T. Atasü, Ü. Özekici ve N. Hekim (Edl.), Jinekoloji (ss. 657-674). Nobel Tıp Kitabevleri.
  • Auvinen-Lintunen, L., Lindgren, M., Tikkanen, R. ve Ilonen, T. (2015). Mental imagery and movement responses to the Rorschach test among young violent offenders. Rorschachiana, 36, 201-220.
  • Avis, N. E., Crawford, S. L., Greendale, G., Bromberger, J. T., Everson-Rose, S. A., Gold, E. B. ve Thurston, R. C. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 175(4), 531-539. https://doi.org/10.1001/ jamainternmed.2014.8063.
  • Bateman, A. ve Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder. World Psychiatry, 9, 11-15.
  • Baudin, M. (2005). Vieillir au féminin. Psychologie Clinique et Projective, 11, 277-288.
  • Berent-Spillson, A., Marsh, C., Persad, C., Randolph, J., Zubieta, J. K. ve Smith, Y. (2017). Metabolic and hormone influences on emotion processing during menopause. Psychoneuroendocrinology, 76, 218-225.
  • Bion, W.R. (2014). Yaşayarak öğrenmek. (T. Güvenir ve L.İ. Ekin, Çev.). Bağlam Yayınları. (1962)
  • Bromberger, J. T., Kravitz, H. M., Chang, Y., Randolph, J. F., Avis, N. E., Gold, E. B. ve Matthews, K. A. (2013). Does risk for anxiety increase during the menopausal transition? Study of women’s health across the nation. Menopause: the Journal of the North American Menopause Society, 20(5), 488-495. https://doi.org/10.1097/ gme.0b013e3182730599
  • Bryant, J., Judd, F. K. ve Hickey, M. (2012). Anxiety during the menopausal transition: A systematic review. Journal of Affective Disorders, 139, 141–148.
  • Bouchard, M. A., Target, M., Lecours, S., Fonagy, P., Tremblay, L. M., Schachter, A. ve Stein, H. (2008). Mentalization in adult attachment narratives: Reflective functioning, mental states, and affect elaboration compared. Psychoanalytic Psychology, 25(1), 47–66. https://doi.org/10.1037/0736-9735.25.1.47
  • Chou, H. F. ve Schneider, J. K. (2012). Self-regulation of menopause. Menopause: the Journal of the North American Menopause Society, 19(5), 534-540. https://doi.org/10.1097/ gme.0b013e318238f74b
  • Conklin, A. C., Malone, J. C. ve Fowler, J. T. (2012). Mentalization and the Rorschach. Rorschachiana, 33, 189–213. https://doi.org/10.1027/1192-5604/a000035
  • Çetin, M. T. (2000). Klimakterik dönemde kanama düzensizlikleri. İçinde E. Ertüngealp ve H. Seyisoğlu (Edl.), Menopoz ve Osteoporoz (ss. 28-37). Ulusal Menopoz ve Osteoporoz Derneği Yayınları.
  • Dejonghe, M., Malempré, M. ve Richelle, J. (2007). Apport du test de Rorschach dans l'évaluation diagnostique et pronostique d'adolescents auteurs d'infractions à caractère sexuel. Psychologie Clinique et Projective, 13, 347-369.
  • Dimitrijević, A., Hanak, N., Altaras Dimitrijević, A. ve Jolić Marjanović, Z. (2018). The Mentalization Scale (MentS): A self-report measure for the assessment of mentalizing capacity. Journal of Personality Assessment, 100(3), 268-280.
  • Ertem, G. (2010). Kadınların menopoz sonrası yaşam kalitelerinin incelenmesi. Uluslararası İnsan Bilimleri Dergisi, 7, 469-483.
  • Freeman, E. W, Sammel, M. D, Lin, H. ve Nelson, D. B. (2006). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archieves of General Psychiatry, 63, 375–382.
  • Frey, B. N., Hall, G. G., Attard, S., Yücel, K., Skelin, I., Steiner, M. ve Soares, C. (2010). Shift in the brain network of emotional regulation in midlife women: Is the menopausal transition the turning point? Menopause: the Journal of the North American Menopause Society, 17(4), 840-845. https://doi.org/10.1097/gme.0b013e3181df840f
  • Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y. W., Warren, F., Howard, S. ve Lowyck, B. (2016). Development and validation of a self-report measure of mentalizing: The Reflective Functioning Questionnaire. PLOS ONE, 11(7), e0158678. https://doi.org/10.1371/journal.pone.0158678
  • Fonagy, P., Target, M., Steele, H. ve Steele, M. (1998). Reflective-functioning manual, version 5.0, for application to adult attachment interviews. University College London.
  • Gori, A., Arcioni, A., Topino, E., Craparo, G. ve Lauro Grotto, R. (2021). Development of a new measure for assessing mentalizing: The multidimensional mentalizing questionnaire (MMQ). Journal of Personalized Medicine, 11(4), 305.
  • Ha, C., Sharp, C., Ensink, K., Fonagy, P. ve Cirino P. (2013). The measurement of reflective function in adolescents with and without borderline traits. Journal of Adolescence, 36, 1215–1222.
  • Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar ve Villiers, T. J. (2012). Executive summary of the stages of reproductive aging workshop+10: Addressing the unfinished agenda of staging reproductive aging. Climacteric, 15 (2), 105–114. https://doi.org/10.3109/13697137.2011.650656
  • Hunter, M. ve O'Dea I. (2001). Cognitive appraisal of the menopause: The menopause representations questionnaire. Psychology, Health & Medicine, 6(1), 65-76. https://doi.org/10.1080/713690224
  • İkiz, T. (2017). Rorschach Testi psikanalitik yorum kodlama ve uygulamalar. Bağlam Yayınları.
  • İkiz, T. T., Atak, İ. E., Düşgör, B. P. ve Zabcı, N. (2009). Rorschach kodlama kitabı 2: Yetişkin normları. Bağlam Yayınları.
  • Kandemir, F., İkiz, T. ve Sever, A. E. (2018). Postmenopozal süreçteki kadınların ruhsal işleyişlerinin projektif testler aracılığıyla değerlendirilmesi. Yansıtma; Psikopatoloji ve Projektif Testler Dergisi, 29, 65-78.
  • Kandemir, F. (2010). Post menopoz sürecindeki kadınların ruhsal yönden değerlendirilmesi [Yayımlanmamış yüksek lisans tezi]. İstanbul Üniversitesi.
  • Katznelson, H. (2014). Reflective functioning: A review. Clinical Psychology Review, 34, 107–117.
  • Kulkarni, J., Gavrilidis, E., Hudaib, A. R., Bleeker, C., Worsley, R. ve Guvich, C. (2018). Development and validation of a new rating scale for perimenopausal depression-the Meno-D. Translational Psychiatry, 8(123). https://doi.org/10.1038/s41398-018-0172-0
  • Lecours, S. ve Bouchard, M. A. (1997). Dimensions of mentalisation: Outlining levels of psychic transformation. The International Journal of Psycho-Analysis, 78, 855-875.
  • Levy, R. (2010). Adolescence: The body as a scenario for non-symbolized dramas. İçine M. Aisenstein ve E. Rappoport (Edl.), Psychosomatics Today: A Psychoanalytic Perspective (ss. 93-110). Karnac Books Ltd.
  • Marty, P. (2012). Zihinselleştirme ve psikosomatik (A. E. Sever, Çev.). Bağlam Yayınları. (1991)
  • Matthews, K. A. ve Bromberger, J. T. (2005). Does the menopausal transition affect health-related quality of life? The American Journal of Medicine, 118, 25-36.
  • Mauas, V., Kopala-Sibley, D. C. ve Zuroff, D. C. (2014). Depressive symptoms in the transition to menopause: The roles of irritability, personality vulnerability, and self-regulation. Archieves of Women’s Mental Health, 17, 279–289. https://doi.org/10.1007/s00737-014-0434-7
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There are 52 citations in total.

Details

Primary Language Turkish
Subjects Psychology
Journal Section Research Article
Authors

Fatma Kandemir 0000-0003-3114-5328

Tevfika İkiz 0000-0002-8183-6832

Publication Date May 31, 2023
Submission Date January 18, 2021
Acceptance Date March 5, 2023
Published in Issue Year 2023 Volume: 10 Issue: 2

Cite

APA Kandemir, F., & İkiz, T. (2023). Menopozal Süreçte Zihinselleştirme Kapasitesi ve Determinantları. AYNA Klinik Psikoloji Dergisi, 10(2), 214-242. https://doi.org/10.31682/ayna.863586