Fostering change in personality configurations: Anaclitic and introjective patients in psychoanalysis.

Werbart, Andrzej; Levander, Sonja

doi:10.1037/pap0000022

Cited by 14 publications

(30 citation statements)

References 61 publications

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“…increasingly become competitive and critical of the therapist's interventions. As such, for any therapy to be effective, its techniques would have to be adapted to these particular underlying personality features and their different concerns and needs (e.g., Blatt, 2004;Blatt & Auerbach, 2001;Bleichmar, 2010;Fonagy, Luyten, & Bateman, 2015;Werbart & Levander, 2016). Existing research has indeed shown that both personality dimensions may influence treatment outcome, regardless of treatment modality.…”

mentioning

confidence: 99%

Personality and outcome in individuals with treatment-resistant depression—Exploring differential treatment effects in the Tavistock Adult Depression Study (TADS).

Rost¹,

Luyten²,

Fearon³

et al. 2019

Journal of Consulting and Clinical Psychology

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Objective: Although research over the past decades has investigated the impact of the personality dimensions of dependency and self-criticism on treatment outcome, little is known of how these personality features influence responsiveness to treatment in patients with severe, chronic forms of depression. Method: The present study uses data from the Tavistock Adult Depression Study (TADS), a randomized controlled trial investigating the effectiveness of long-term psychoanalytic psychotherapy (LTPP) compared with treatment as usual (TAU) for individuals diagnosed with treatment-resistant depression. Patients were rated with the Anaclitic Introjective Depression Assessment Q-sort, which distinguishes between two more maladaptive (Submissive and Dismissive) and two less maladaptive (Needy and Self-Critical) subdimensions of dependent or anaclitic and self-critical or introjective depression. Multilevel modeling was used to compare individuals' growth curves of depression severity as measured by the Hamilton Rating Scale for Depression over the 18months treatment period and two-year follow-up. Rates of clinically significant change were also determined. Results: As expected, depressed patients with more maladaptive dependent and self-critical features did not benefit from LTPP or TAU. Patients with less maladaptive self-critical features benefitted from both LTPP and TAU, while those with less maladaptive dependent features showed considerable gains from LTPP but not from TAU, with medium to large effect sizes. Conclusions: Findings of this study are consistent with existing research suggesting the need to modify and tailor treatments in accordance to individuals' pretreatment personality features. Given the time and cost-intensive nature of longer-term treatment, this may be particularly important in patients with treatment-resistant depression.

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confidence: 99%

Personality and outcome in individuals with treatment-resistant depression—Exploring differential treatment effects in the Tavistock Adult Depression Study (TADS).

Rost¹,

Luyten²,

Fearon³

et al. 2019

Journal of Consulting and Clinical Psychology

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“…The data were collected between 1997 and 2008 at intake, termination, and 2-year follow-up and included the following instruments: the Symptom Checklist-90-R (SCL-90; Derogatis, 1994), the Structural Analysis of Social Behavior (SASB) Intrex Questionnaire (Benjamin, 1987), and the Sense of Coherence (SOC) Scale (Antonovsky, 1987). The data were previously used in two studies of changes in anaclitic-introjective personality dimensions following psychoanalysis (Werbart and Forsström, 2014;Werbart and Levander, 2016). The present study is based on 14 patient interviews at termination and 12 patient interviews at 2-year follow-up (26 patient interviews in total).…”

Section: Data Collectionmentioning

confidence: 99%

“…Most patients showed positive outcomes in terms of symptom reduction (SCL-90) and improved quality of life (SOC), and the proportion of patients showing clinically significant change was comparable to data presented by de Maat et al 2013, while changes in positive and negative self-concept (SASB) were more limited. For more detailed outcome data, see Werbart and Forsström (2014) and Werbart and Levander (2016).…”

Section: Participantsmentioning

confidence: 99%

“…Furthermore, qualitative studies demonstrated that the anaclitic and the introjective patients in psychoanalysis differ in their experiences of helpful and hindering factors in psychoanalysis and in their experiences of the analyst (Levander and Werbart, 2012;Werbart and Levander, 2016). The anaclitic patients talked of trust and a wish for support from their analyst, whereas the introjective patients wanted help with their control and in maintaining distance from others.…”

Section: Introductionmentioning

confidence: 99%

“…In another sample, patients' pictures of their analysts after termination bore the stamp of the patients' predominant personality orientation. Anaclitic patients described both positive and negative aspects of their relationship, whereas introjective patients focused on both positive and negative aspects of the therapist as a separate individual (Werbart and Levander, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Love, Work, and Striving for the Self in Balance: Anaclitic and Introjective Patients’ Experiences of Change in Psychoanalysis

2020

Self Cite

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One of the most famous quotations credited to Freud is that, when asked what he thought a psychologically healthy person should be able to do, he said: "to love and to work." A central goal in psychoanalytic treatment is to bring about changes in basic, mostly unconscious, mental structures. The aim of this study was to investigate, applying an inductive thematic analysis, the experiences anaclitic and introjective patients have had of change after psychoanalysis with regard to the domains Love and Relationships and Work and Achievements. Analyzing patient interviews, we identified a third domain of experienced changes, The Self, which refers to increased self-understanding, self-acceptance, and self-care rather than an improved dynamic balance between love and work. All patients experienced several positive changes in their lives during and after psychoanalysis. We also found distinctive patterns that appear to be closely linked to the patients' initial personality orientation with regard to relationships and achievements. Generally, the patients described symmetrical, but opposite, change processes within the two specific domains of Love and Work. For the anaclitic patients, this indicated a movement inward in the domain of Love (from an excessive preoccupation with issues of their relationship with others toward more distinct self-boundaries and increased agency) and outward in the domain of Work (from unenterprising toward becoming more outgoing and daring). For the introjective patients, this pointed to a reverse movement outward in the domain of Love (from an excessive preoccupation with issues of autonomy toward increased responsiveness to others and desire to be establish close, mutual relationships) and inward in the domain of Work (from an excessive orientation on achievements toward increased becoming more grounded in their own feelings, needs, and desires). In conclusion, patients in both groups have experienced a reduced preoccupation with issues related to their initially predominant personality dimension (relatedness or self-definition) and increased receptivity to needs typical for the complementary dimension. These changes seem to be mediated by changes in the domain of The Self. Our study suggests the clinical relevance of focusing the therapeutic work on fostering a better and more dynamic balance between love and work, relatedness, or self-definition.

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Matching Patient and Therapist Anaclitic–Introjective Personality Configurations Matters for Psychotherapy Outcomes

Werbart

Hägertz

Ölander

2018

J Contemp Psychother

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Decades of psychotherapy research suggest that patient–therapist match accounts for outcome beyond single patient or therapist variables. This study examines the associations between different patterns of patient–therapist matching (in terms of orientation on relatedness or self-definition) and outcomes at termination of psychoanalytic psychotherapy with young adults. Thirty-three patients and their therapists were classified as predominately anaclitic or introjective at baseline. Patients in the convergent patient–therapist dyads (both anaclitic or both introjective) showed significantly greater symptom reduction and increased developmental levels of representations of mother than patients in the complementary dyads (opposite personality configurations). Moreover, convergent patient–therapist match was connected with larger effect sizes on all outcome measures and lower proportion of non-improved patients. These findings suggest the importance of the therapists’ early adjusting their orientation on relatedness or self-definition to their patients’ predominant personality configuration in order to enhance treatment outcomes.

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Fostering change in personality configurations: Anaclitic and introjective patients in psychoanalysis.

Cited by 14 publications

References 61 publications

Personality and outcome in individuals with treatment-resistant depression—Exploring differential treatment effects in the Tavistock Adult Depression Study (TADS).

Personality and outcome in individuals with treatment-resistant depression—Exploring differential treatment effects in the Tavistock Adult Depression Study (TADS).

Love, Work, and Striving for the Self in Balance: Anaclitic and Introjective Patients’ Experiences of Change in Psychoanalysis

Matching Patient and Therapist Anaclitic–Introjective Personality Configurations Matters for Psychotherapy Outcomes

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