Relationship of sociotropy/autonomy and dependency/self-criticism to DSM-III-R personality disorders

Assessing Personality Change with Blatt's Anaclitic and Introjective Configurations and Shedler-Westen Assessment Procedure Profiles: Two Case Studies in Psychodynamic Treatment

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.

The Contribution of Sidney Blatt's Two-Polarities Model to the Psychodynamic Diagnostic Manual

This article reviews the theoretical and empirical contributions of Blatt's two-polarities model of personality development and psychopathology to the second edition of the Psychodynamic Diagnostic Manual (PDM-2). First, we briefly provide an overview of the manual's main features and describe the guiding principles of the revision process. We then discuss in more detail how Blatt's model, which is focused on the dialectic interaction between anaclitic-introjective and relatedness vs self-definition dimensions in both normal and disrupted personality development, increases the PDM-2's theoretical and empirical comprehensiveness and clinical utility, especially concerning the classification and assessment of personality and overall mental functioning in adult populations. Finally, we address the implications for the therapeutic process, showing how anaclitic and introjective patients may be differentially responsive to different psychodynamic techniques (e.g., supportive or expressive interventions). Taken together, these considerations demonstrate the importance of a more theory-driven and empirically informed diagnostic system that embraces, in accordance with Sidney Blatt's empirically supported and psychoanalytically-oriented ideas, the complexities of human experience (both normal and pathological) and captures the subjective and underlying dynamics of psychological symptoms and syndromes.

Personality Factors and Depressive Configurations. An Exploratory Study in an Italian Clinical Sample

Introduction: This study focuses on the relationship between personality configurations and depressive experiences. More specifically, the aim of this study is to investigate the relationship between self-criticism and dependency and personality styles or disorders, exploring the association between personality features and depressive symptoms. The two-configurations model of personality developed by Blatt (2004, 2008) is adopted as a reference point in sharing a valid framework and in understanding the results.

Methods: Five instruments are administered to 51 participants with a diagnosis of depressive disorder, in accordance with DSM-IV-TR (American Psychiatric Association, 2000): Self-criticism and dependency dimensions of depression are measured with the Depressive Experiences Questionnaire (DEQ); self-reported depression is assessed with the Beck Depression Inventory-II (BDI-II); observer-rated depression is assessed with the Hamilton Depression Rating Scale (HDRS); personality is assessed with the Clinical Diagnostic Interview (CDI) and the Shedler Westen Assessment Procedure-200 (SWAP-200).

Results: Only self-criticism, and not dependency, is associated with depressive symptoms. In addition, the SWAP Borderline PD Scale and the Dysphoric: Emotionally dysregulated Q-factor emerge as significant in predicting depression.

Conclusions: Findings support the assumption that depressive personality configurations can enhance the vulnerability to developing depression. Theoretical and clinical implications of these results are discussed.

Observing the determinants of the psychotherapeutic process in depressive disorders. A clinical case study within a psychodynamic approach

This paper focuses on the relationship between depressive disorders, personality configurations, and mental functioning. A one-year treatment of a young man with the diagnosis of Depression is presented: the clinical and empirical points of view are described in depth through an assessment at the beginning and at one year after of an oriented psychodynamic psychotherapy. SCID I and II and HAMRS were administered to the patient in assessment phase. In the same phase he filled in BDI-II, and DEQ; the psychotherapist completed SWAP-200. These clinician instruments were used again after 1 year of the treatment. The PDM point of view is also presented. All sessions are audiotaped: 12 verbatim transcripts were coded with the Defense Mechanisms Rating Scale and CCRT. The results show a decrease in depressive symptoms, a change in some personality configurations, but a substantial invariance of the introjective profile, and a modification in mental functioning.

Dysfunctional Attitudes and Symptom Expression in Schizophrenia: Differential Associations With Paranoid Delusions and Negative Symptoms

The extent to which dysfunctional attitudes reflecting excessive need for interpersonal acceptance and approval and/or unrealistic performance standards and interpersonal distance are associated with patterns of symptoms in patients with psychiatric disorders other than depression has been hypothesized but little tested. This study aimed to assess the relations among dysfunctional attitudes and symptoms of psychopathology in patients with DSM-IV-diagnosed schizophrenia (N = 56). The interpersonal and performance-related subscales of the Dysfunctional Attitudes Scale (Weisman & Beck, 1978) were assessed in relation to self-report and clinician-based symptom measures of psychosis, general psychopathology, and depression. The severity of paranoid ideation was found to be uniquely associated with elevated need-for-approval scores, whereas the constellation of negative symptoms was found to be uniquely associated with dysfunctional performance beliefs, even after controlling for depression severity. These results provide preliminary support for the importance of personality attributes in the particular expression of symptoms of psychosis.