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

Abstract

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.

Loss of Rituals, Boundaries, and Relationship: Patient Experiences of Transition to Telepsychotherapy Following the Onset of COVID-19 Pandemic

“…Extensive research has shown that personality characteristics influence what patients are looking for when seeking psychotherapeutic help, how they make use of therapy, and how helpful different forms of therapy are for them ( Blatt et al, 2001 ; Blatt and Shahar, 2004a , b ; Blatt and Luyten, 2009 ; Levander and Werbart, 2012 ; Werbart and Levander, 2016 ; Werbart et al, 2020 ). According to Blatt’s (2008) empirically supported theoretical “double helix” model, psychological development is a lifelong interplay between two basic dimensions in human experiences: the anaclitic orientation on interpersonal relatedness (ability to develop empathic, reciprocally attuned relationships) and the introjective orientation on self-definition (ability to establish a coherent, realistic, differentiated and positive sense of self).…”

“…They tend to keep others at a distance and make the best use of interpretative interventions in psychotherapy. Consequently, anaclitic patients seem to value and are more responsive to the quality of the therapeutic relationship, whereas introjective patients lay emphasis on increasing their understanding of themselves ( Blatt and Shahar, 2004b ; Blatt and Luyten, 2009 ; Levander and Werbart, 2012 ; Luyten and Blatt, 2013 ; Werbart and Levander, 2016 ; Werbart et al, 2017 , 2020 ; Hennissen et al, 2020 ). Anaclitic patients seem to benefit more from therapy with a greater relational focus on interaction in a face-to-face setting, where the therapist and patient can see one another, whereas introjective patients seem to benefit more from psychoanalytic therapy with a greater focus on insight and self-reflection, lying on the couch, where the patient does not see their therapist ( Blatt et al, 1988 , 2007 , 2010 ; Blatt, 1992 ; Blatt and Ford, 1994 ; Blatt and Shahar, 2004b ).…”