Assessing personality change with Blatt's anaclitic and introjective configurations and Shedler-Westen Assessment Procedure profiles: two case studies in psychodynamic treatment

Abstract

A growing body of empirical and clinical research attests to the influence of personality features on the development, course and outcome of psychotherapy. Over the last four decades, Blatt adopted a psychoanalytic and cognitive developmental approach in developing a theoretically and empirically grounded two-configurations model of personality. The main aim of this study was to evaluate possible changes in anaclitic and introjective configurations – as measured by the Depressive Experience Questionnaire (DEQ) (Blatt, D’Afflitti, & Quinlan, 1976) – set against simultaneous changes in personality profile measured by Shedler-Westen Assessment Procedure (SWAP-200). Two young patients, a man and a woman, characterized by different personality profiles – introjective and anaclitic, respectively – were assessed for one year in the context of a psychodynamic psychotherapy. A battery of instruments – Beck Depression Inventory II (BDI-II), Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders I and II, Defense Mechanism Rating Scale, DEQ and SWAP-200 – were administered at the beginning, during the assessment process, and after one year. Both patients displayed lower BDI-II scores, along with evident clinical progress. Defence profiles and Core Conflict Relationship Themes showed interesting developments, in keeping with the evolution of the psychotherapy process. Lastly, while DEQ profiles outlined substantial stability after one year, some important changes in SWAP-200 profiles – in particular with regard to Q factors – were observed. Although these findings should be considered as preliminary, these results appear to be consistent with the description of Self-criticism and Dependency as relatively stable personality dimensions. The potential influence of profile diversity – introjective vs anaclitic – on other key variables of the psychotherapy process is also discussed.

Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation

“…At the more immature levels, defenses act a massive image distortions and withdrawn of charged feelings, while more adaptive defense levels allow higher awareness of feelings, ideas, thus maximize gratification and resilience (Di Giuseppe, Prout, Fabiani, & Kui, 2020). Immature defense mechanisms are often associated to various levels of severity of psychological functioning and different psychopathological conditions, especially personality disorders (e.g., Di Giuseppe, Gennaro et al, 2019;Hilsenroth, Callahan, & Eudell, 2003;Lingiardi et al, 1999;Oasi et al, 2017;Perry, Presniak, & Olson, 2013). On the other hand, mature defense mechanisms are associated with physical and psychological health and better adjustment (Hayden et al, 2021;Martino et al, 2020).…”

Extending Blatt’s two-polarity model of personality development to dissociative identity disorder: a theory-building case study

“…This procedure has been applied in other theorybuilding case studies involving patients with obsessional complaints (Cornelis et al, 2017a;2017b). CCRT has been used in case study research by Oasi et al (2017).…”

Clinic and research: the therapeutic rhythm

“…For instance, impulsivity and emotional dysregulation have been found to be associated with higher levels of psychiatric and ED symptoms at treatment termination, and then to be possibly related to unfavorable treatment outcomes (Muzi et al, 2021). Even though symptomatic remission is considered a fundamental outcome for a successful therapy, symptom reduction itself is not the only feature to consider with respect to therapeutic change (Oasi et al, 2017). Thus, a possible key aspect is to evaluate changes in more "structural" dimensions of patients' functioning, such as specific personality features and overall personality functioning.…”