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

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.

Language and the Symptoms of Mental Illness Connection via Abstract Representations of the Self and the World

The aim of the present study is to provide additional knowledge about the mediatory processes through which language contributes to the symptoms of mental illness. Although recent studies have provided insight about the relationship between language and the indicators of mental illness, the role of intervening variables in this connection has been ignored. The present investigation tested a structural equation model in which the need for the absolute truth about self and worry mediated the relationship of the gap between inner psychological experience and language with anxiety and depression. The results have provided support for the model and showed that the gap predicts both the need for absolute truth and worry which, in turn, predict the levels of anxiety and depression. The results have been discussed in the light of previous research, and implications for future research have also been considered.

Does interpersonal dependency affect therapeutic outcome? A meta-analytic review

This study examined whether interpersonal dependency affects therapeutic outcome, using meta-analytic techniques to synthesize results from 31 studies (49 effect sizes; overall N = 3807). High levels of dependency were associated with more positive outcome in psychodynamic therapy (r = 0.11, p < 0.05), but not cognitive-behavioural therapy (r = -0.05, ns), and were associated with a less positive outcome in pharmacological treatment (r = -0.15, p < 0.001). Other predictors of outcome included patient diagnosis (high levels of dependency were linked with more positive outcome for patients with anxiety disorders but not those with depression), outcome measure (high levels of dependency were associated with significantly greater improvement in global functioning but not symptom reduction) and dependency measure (cognitive and cognitive-behavioural dependency scales yielded less positive results than other types of measures). These results contribute to a growing body of literature examining effects of personality on treatment process and outcome. © 2019 John Wiley & Sons, Ltd.

Relationship of the gap between experience and language with mental health in adolescence: the importance of emotion regulation

Although past research has provided important information about the relationship between language use and mental health in the period of adolescence, the role of intervening variables in this association has been seriously neglected. The aim of the present study was to illuminate the association between language use (operationalized by "the gap between experience and language--GAP") and mental health (e.g., adjustment and depression, with the mediator role of emotion regulation). Three-hundred-and-seventy-four adolescents (220 female, 154 male; 16.08 mean age) participated in the study. The results provided support for the mediator role of emotion regulation in the relationship between GAP and mental health. Moreover, it was shown that the relationship between emotion regulation and depression was mediated by adjustment.

Linguistic measures of the referential process in psychodynamic treatment: the English and Italian versions

The referential process is defined in the context of Bucci's multiple code theory as the process by which nonverbal experience is connected to language. The English computerized measures of the referential process, which have been applied in psychotherapy research, include the Weighted Referential Activity Dictionary (WRAD), and measures of Reflection, Affect and Disfluency. This paper presents the development of the Italian version of the IWRAD by modeling Italian texts scored by judges, and shows the application of the IWRAD and other Italian measures in three psychodynamic treatments evaluated for personality change using the Shedler-Westen Assessment Procedure (SWAP-200). Clinical predictions based on applications of the English measures were supported.

Client Contact in Self-Help Therapy for Anxiety and Depression: Necessary But Can Take a Variety of Forms Beside Therapist Contact

Self-administered therapies (SATs) have been promoted as a way to increase access to evidence-based mental health services. Recent meta-analyses and literature reviews suggest that SATs with clinical guidance are more effective than SATs with no contact for the treatment of anxiety and depression. However, little attention has been paid to the role of nonguidance contact, contact that does not involve the provision of assistance in the application of specific therapy techniques such as emails to encourage treatment adherence. The present article examines the impact of nonguidance contact on the outcomes of SATs for anxiety and depression. Electronic databases were searched to identify studies conducted over the past two decades by independent research teams that have tested cognitive-behavioural SATs over multiple trials. Findings suggest that the involvement or guidance of a therapist is not essential for SATs to produce significant benefits as long as nonguidance contact is provided. It is suggested that even very minimal levels of nonguidance contact increase SAT's outcomes by motivating treatment engagement and improving adherence. The benefit of SATs that can be accessed directly by large numbers of individuals and that do not require therapist involvement to ensure efficacy can potentially significantly increase the cost effectiveness and quality of mental health service delivery.

The gap that makes us desperate: paths from language to mental health

Although past research provided some clues about the relation of language use with mental health, the mediatory functions of personality variables in this relationship have been ignored. This research examined the mediatory role of self-concept clarity in the relationship between language use perceived by individuals and mental health indicators including anxiety, depression, and alexithymia. Based on the theoretical framework suggested by Şimşek (2010), two studies sought to test two alternative structural equation models in data from university students in the first study (n = 250) and data from other groups in the second study (n = 331). The first model assumed that the relationship of language use with anxiety, depression, and alexithymia was mediated by self-concept clarity. The second model tested the mediatory role of both anxiety and self-concept clarity in this relationship. The results of the first study showed that the second model fitted better to the data than the first. Consistent with the first study, the results of the second study confirmed that the second model produced better goodness of fit statistics than the first model.

Measurement of negativity bias in personal narratives using corpus-based emotion dictionaries

This study presents a novel methodology for the measurement of negativity bias using positive and negative dictionaries of emotion words applied to autobiographical narratives. At odds with the cognitive theory of mood dysregulation, previous text-analytical studies have failed to find significant correlation between emotion dictionaries and negative affectivity or dysphoria. In the present study, an a priori list dictionary of emotion words was refined based on the actual use of these words in personal narratives collected from close to 500 college students. Half of the corpus was used to construct, via concordance analysis, the grammatical structures associated with the words in their emotional sense. The second half of the corpus served as a validation corpus. The resulting dictionary ignores words that are not used in their intended emotional sense, including negated emotions, homophones, frozen idioms etc. Correlations of the resulting corpus-based negative and positive emotion dictionaries with self-report measures of negative affectivity were in the expected direction, and were statistically significant, with medium effect size. The potential use of these dictionaries as implicit measures of negativity bias and in the analysis of psychotherapy transcripts is discussed.

Language and the Inner

The nexus between language and experience addresses the distinct, qualitative aspects of human experience or qualia. These qualitative aspects are important because, when people perceive a disconnect between language and experience, consequences for psychological health may follow. The research reported herein aimed to develop and validate a psychometric tool to assess perceptions of connection between language and experience. Six studies were conducted to confirm the factor structure of the Beliefs About the Functions of Language scale and to assess its construct validity. Two factors were derived and validated (viz. epistemic and communicative), which were shown to relate to mental health indicators in expected ways.

A structural-developmental psychodynamic approach to psychopathology: two polarities of experience across the life span

Consistent with principles of developmental psychopathology, this paper presents a broad psychodynamic structural developmental perspective that establishes conceptual continuities between processes of normal personality development, personality organization, concepts of psychopathology, and processes of therapeutic change. The major assumption of this approach is that personality development proceeds in a dialectic synergistic interaction between the development of capacities for interpersonal relatedness and the development of self-definition or identity. Extensive research demonstrates that these two dimensions define two broad types of personality organization, each with a particular experiential mode; preferred forms of cognition, defense, and adaptation; unique qualities of interpersonal relatedness and specific types of object and self-representation. Severe disruptions of this normal dialectic developmental process result in various forms of psychopathology organized in two basic configurations in which there is distorted defensive preoccupation, at different developmental levels, with one of these polarities (relatedness or self-definition) at the expense of the development of the other dimension. This paper reviews empirical findings supporting this approach to normal and disrupted personality development throughout the life cycle and considers its relationship to the internalizing-externalizing distinction in childhood and adolescence, attachment theory, and research on the interaction between biological and psychosocial factors in development across the life span. Finally, we discuss the implications of this approach for intervention and prevention.

Psychoanalysis--with whom, for what, and how? Comparisons with psychotherapy

If psychoanalytic treatment is to survive in the era of evidence-based medicine and managed care systems, empirical evidence is needed to demonstrate its unique nature and effectiveness. To address this need, comprehensive analyses were conducted of data from the Menninger Psychotherapy Research Project (Wallerstein 1986). These analyses addressed three questions: (1) What are the differences in outcome between psychoanalysis (PSA) and supportive-expressive psychotherapy (SEP)? (2) With what types of patient, and in what ways, are these two psychodynamic treatments differentially effective? (3) Are these differences in outcome the consequence of possibly different mechanisms of therapeutic action? PSA was found to contribute significantly to the development of adaptive interpersonal capacities and to the reduction of maladaptive interpersonal tendencies, especially with more ruminative, self-reflective, introjective patients, possibly by extending their associative capacities. SEP, by contrast, was effective only in reducing maladaptive interpersonal tendencies and only with dependent, unreflective, more affectively labile anaclitic patients, possibly by containing or limiting their associative capacities.