Beyond self-criticism and dependency: structural functioning of depressive patients and its treatment

Abstract

Van Praag states that the underlying psychic dysfunctions in psychopathology must be evaluated (and treated) in patient-centered treatments. In line with this idea, Blatt and colleagues propose the concept of self-critical (introjective) and dependent (anaclitic) functioning. The research program Millennium Initiative has studied self-critical and dependent functioning from different perspectives. The general aim of this paper is to share the results of the program that have contributed to clinical psychotherapeutic thinking. Its first specific aim is to summarize results reported elsewhere that support the predictive value of introjective and anaclitic functioning (Part I), while its second specific aim is to report original data that account for the structural functioning of personality underlying these two constructs (Part II). The results (Part I) show that self-critical functioning is associated with greater reactivity to stress (according to cortisol level in stress tasks) and less subjective awareness of stress, reduced performance in general tasks, and lower mentalization (errors in reading faces); also, patients with introjective (self-critical) depression receiving psychotherapy have more symptoms at onset, higher dropout rates, and poorer response to interventions than anaclitic (dependent) patients. Higher self-criticism was associated with higher depression scores; also, when comparing clinical and nonclinical samples, the latter showed less self-criticism. Therefore, self-critical functioning represents a challenge for researchers and clinicians. The evaluation of the structural functioning of personality showed (Part II) that self-critical functioning is associated with less integrated levels of structure and more depressive symptoms. This functioning is underlain by vulnerabilities in the abilities regulating object relationships and attachments to internal objects. Dependent functioning is associated with vulnerabilities in self-perception, self-regulation, and attachments to external objects. The psychotherapeutic implications of these results are discussed, paying special attention to aspects connected with structure-oriented psychotherapy.

A psychodynamic contribution to the understanding of anger - The importance of diagnosis before treatment

“…In this context, we believe that a possible priority could be to try and identify elements that are primarily useful for diagnostic (and therefore therapeutic) purposes. A similar process is highlighted by de la Parra et al ( 2017 ) with respect to depression.…”

Risk Factors for Adult Depression: Adverse Childhood Experiences and Personality Functioning

“…At the same time, what is usually described as "depression" is a heterogeneous construct (Fried and Nesse, 2015), which does not only point toward different symptom profiles, but also to a thorough assessment of the impact of risk factors and vulnerabilities. This is of practical relevance, as different pathways to the development and course of depression may also interact with the selection of treatments that suits the patient best (De la Parra et al, 2017), and identify strategies for relapse prevention (Ingram and Price, 2010).…”

“…Finally, other studies report that depressive styles such as self-critical and dependent (Blatt, 2004) will develop predispositions to stressors and show different responses for treatment (Dagnino et al, 2018), as well as personality vulnerabilities that are specific to each type of depressive style (OPD Working Group, 2008;Dagnino et al, 2017;De la Parra et al, 2017).…”

Impacto de la Personalidad y el Estilo Depresivo en los Resultados Psicoterapéuticos de Pacientes con Depresión

“…Para ello se debe contar con una descripción más precisa y completa del paciente, tomando en cuenta sobre todo aquellas disfunciones que deben considerarse como focos del tratamiento, como son las vulnerabilidades estructurales(Corveleyn, Luyten & Blatt, 2005;van Praag, 2010). Solo así se podrán desarrollar estrategias centradas en el paciente y no en el síndrome (de la Parra,Dagnino, Valdés & Krause, 2017).…”