Use of the TAT to Measure Change in Defense Mechanisms Following Intensive Psychotherapy

Changes in the use of defense mechanisms (denial, projection, and identification) were examined over a period of approximately 15 months of intensive treatment of 90 seriously disturbed young adults who were hospitalized in an intensive, open, long-term treatment setting. Patients independently judged to have primarily an anaclitic or an introjective personality configuration (Blatt, 1974, Blatt & Shichman, 1983) were assessed for psychiatric symptoms and aspects of interpersonal behavior both on admission and after an average of 15 months of treatment. Findings based on an independent assessment of TAT protocols at these two times indicated a significant (p < .05) decline in total use of defenses for the entire sample, but especially for introjective patients. Further, this decline in total use of defenses in the TAT was significantly associated with a reduction in psychiatric symptoms. Also, sex-incongruent patients (anaclitic men and introjective women) were found to rise different defenses and to change in ways different from sex-congruent patients (anaclitic women and introjective men).     

The differential effect of psychotherapy and psychoanalysis with anaclitic and introjective patients: the Menninger Psychotherapy Research Project revisited.

Analyses of the data from the Menninger Psychotherapy Research Project (MPRP) have consistently indicated little difference in the therapeutic outcome between patients seen in psychoanalysis and those seen in psychotherapy. Reanalysis of the data from the MPRP, utilizing a distinction between two broad configurations of psychopathology (Blatt, 1974, 1990a; Blatt and Shichman, 1983), however, indicates that patients whose pathology focuses primarily on disruptions of interpersonal relatedness and who use primarily avoidant defenses (anaclitic patients), and patients whose pathology focuses primarily on issues of self-definition, autonomy, and selfworth and who use primarily counteractive defenses (introjective patients) differ in their responsiveness to psychotherapy and psycho-analysis. Based on recently developed procedures for systematically evaluating the quality of object representation on the Rorschach, reanalysis of the Menninger data reveals that anaclitic patients have significantly greater positive change in psychotherapy, while introjective patients have significantly greater positive change in psychoanalysis. These statistically significant patient-by-treatment interactions are discussed in terms of their clinical implications as well as the importance of differentiating among types of patients in studies of therapeutic outcome and of therapeutic process.     

Proximal predictors of depressive symptomatology: perceived losses in self-worth and interpersonal domains and introjective and anaclitic mood states

Although much research has demonstrated a relationship between negative life events and depressive symptoms, relatively little research has examined the mechanisms that may mediate this relationship. The theories of Blatt (1974), Bowlby (1980), and Gilbert (1992) each propose proximal predictors of depression. In accordance with these theories, this study examined the relationships among perceived losses in self-worth and interpersonal relationships, anaclitic (dependent) and introjective (self-critical) mood states, and depressive symptoms following a significant negative life event. A sample of 172 undergraduate students completed measures of depressive symptoms and depressive vulnerability factors and retrospectively described the worst period of their lives. They also rated the extent to which the events surrounding this worst period affected their self-worth and their relationships with close others. Structural equation modeling demonstrated that the effect of a perceived loss of self-worth on depressive symptoms was fully mediated by both introjective and anaclitic mood states, whereas the effect of a perceived loss of interpersonal relationships on depressive symptoms was fully mediated by an anaclitic mood state. Additionally, perceived losses of self-worth showed a stronger effect on introjective mood in highly self-critical individuals. Findings highlight the importance of perceived losses in both self-worth and interpersonal domains in response to adverse life events and suggest pathways through which perceived losses may affect depressive symptoms.     

Proximal Predictors of Depressive Symptomatology: Perceived Losses in Self-Worth and Interpersonal Domains and Introjective and Anaclitic Mood States

Although much research has demonstrated a relationship between negative life events and depressive symptoms, relatively little research has examined the mechanisms that may mediate this relationship. The theories of Blatt (1974), Bowlby (1980), and Gilbert (1992) each propose proximal predictors of depression. In accordance with these theories, this study examined the relationships among perceived losses in self-worth and interpersonal relationships, anaclitic (dependent) and introjective (self-critical) mood states, and depressive symptoms following a significant negative life event. A sample of 172 undergraduate students completed measures of depressive symptoms and depressive vulnerability factors and retrospectively described the worst period of their lives. They also rated the extent to which the events surrounding this worst period affected their self-worth and their relationships with close others. Structural equation modeling demonstrated that the effect of a perceived loss of self-worth on depressive symptoms was fully mediated by both introjective and anaclitic mood states, whereas the effect of a perceived loss of interpersonal relationships on depressive symptoms was fully mediated by an anaclitic mood state. Additionally, perceived losses of self-worth showed a stronger effect on introjective mood in highly self-critical individuals. Findings highlight the importance of perceived losses in both self-worth and interpersonal domains in response to adverse life events and suggest pathways through which perceived losses may affect depressive symptoms.     

Changes in human figure drawings during intensive treatment.

This article examines change in the human figure drawings (HFDs) of 32 seriously disturbed young adults during the course of intensive inpatient treatment. HFDs drawn at the time of admission were compared with HFDs obtained more than 1 year after intensive treatment began; both sets were scored on the Goodenough-Harris Scale (GH) and the Robins Balance-Tilt Scale (RBT). The findings indicate that the HFDs significantly improved over the course of treatment, but only for those patients judged introjective, not anaclitic. These findings are consistent with prior research on the same population that were based on analyses of clinical case records and Rorschach protocols (Blatt, Ford, Berman, Cook, & Meyer, 1988). Significant change in the HFDs over the course of treatment suggests that the HFDs provide a unique and independent dimension for assessing therapeutic change.     

Depressive experiences questionnaire: an empirical exploration of the underlying theory

This article addresses the theoretical conceptualization of depressive typology proposed by Blatt (1974) by analyzing selected items on the Depressive Experiences Questionnaire (DEQ) in a 21-item modified version. Items were selected by judges and by factor loading criteria to be most theoretically characteristic of the dimensions they are meant to represent: anaclitic and introjective depression. Two independent samples, a female inpatient sample and a female college sample, were used. Principal components analysis of these 21 items revealed only 5 anaclitic items and 7 introjective items that loaded on their respective factors for both samples. Inspection of these items suggests that the anaclitic depressive experience is characterized by discomfort with interpersonal separation, whereas the introjective experience is characterized by negative self-evaluation with respect to self-imposed standards. Other putative aspects of these two depressive dimensions were not supported by this study; particularly, guilt and self-blame were not associated with introjective depression.     

Changes in Human Figure Drawings During Intensive Treatment

This article examines change in the human figure drawings (HFDs) of 32 seriously disturbed young adults during the course of intensive inpatient treatment. HFDs drawn at the time of admission were compared with HFDs obtained more than 1 year after intensive treatment began; both sets were scored on the Goodenough-Harris Scale (GH) and the Robins Balance-Tilt Scale (RBT). The findings indicate that the HFDs significantly improved over the course of treatment, but only for those patients judged introjective, not anaclitic. These findings are consistent with prior research on the same population that were based on analyses of clinical case records and Rorschach protocols (Blatt, Ford, Berman, Cook, & Meyer, 1988). Significant change in the HFDs over the course of treatment suggests that the HFDs provide a unique and independent dimension for assessing therapeutic change.     

Dimensions of depression and perfectionism in pregnant and nonpregnant women: their levels and interrelationships and their relationship to marital satisfaction

The authors studied S. J. Blatt's (1974) 2 dimensions of depression (anaclitic and introjective), P. L. Hewitt and G. L. Flett's (1991b) 3 dimensions of perfectionism (socially prescribed, self-oriented, and other-oriented), and the relationship between these and marital satisfaction in 100 married women in the last trimester of their first pregnancy and in 50 married women who had not yet experienced pregnancy. The measures used were the Depressive Experiences Questionnaire (S. J. Blatt, J. P. D'Afflitti, & D. M. Quinlan. 1976a, 1976b), the Multidimensional Perfectionism Scale (P. L. Hewitt & G. L. Flett, 1989), and G. B. Spanier's (1976) Dyadic Adjustment Scale. Pregnant and nonpregnant women did not differ in anaclitic depression, but the level of introjective depression of pregnant women was lower than that of nonpregnant women. The two groups did not differ in level of marital satisfaction or in any of the dimensions of perfectionism. For both groups, introjective depression was positively correlated with socially prescribed perfectionism and negatively correlated with marital satisfaction. Self-oriented perfectionism was positively related to introjective depression and negatively related to marital satisfaction for nonpregnant women. For the pregnant women, there was a negative relationship between socially prescribed perfectionism and marital satisfaction. Anaclitic depression and other-oriented perfectionism were unrelated to any of the other variables studied.     

Changes in anaclitic–introjective personality dimensions,outcomes and psychoanalytic technique: a multi-case study

This study investigates changes in latent mental structures along the anaclitic and introjective dimensions in relation to outcomes in 14 cases of publicly financed psychoanalysis. The method of prototype matching was adapted for personality assessment, and multiple outcome measures were applied. For the anaclitic cases, symptom reduction was accompanied by more mature integration of anaclitic and introjective personality dimensions, while the introjective cases showed symptom reduction without such improvement. This could indicate that sustainable change in latent mental structures is more difficult to achieve in introjective than in anaclitic patients. Further research is needed to validate these preliminary results.     

Commentary: “A Fundamental Polarity in Psychoanalysis: Implications for Personality Development,Psychopathology, and the Therapeutic Process” by Sidney J. Blatt

A commentary on Dr. Sidney J. Blatt's article, “A Fundamental Polarity in Psychoanalysis: Implications for Personality Development, Psycho-pathology, and the Therapeutic Process” is presented by articulating Dr. Blatt's significant contribution to psychoanalysis, developmental and attachment theory, and therapeutic process research. According to Blatt's theory, normal maturation involves a complex reciprocal transaction between two developmental lines throughout the life cycle: (a) the establishment of stable, enduring, mutually satisfying interpersonal relationships and (b) the achievement of a differentiated, stable, and cohesive identity. He has applied this theory to understand both normal and pathological psychological phenomena, the latter resulting from disruptions in these developmental lines, resulting in an overemphasis on relational (anaclitic) or self-definitional (introjective) issues. Further, Dr. Blatt has evaluated his theoretical model through empirical study and demonstrated that relationally oriented and self-definitionally oriented persons have differential responses to psychotherapy. Finally, areas of question and potential for future research are outlined. Specifically, it is argued that although anaclitic and introjective configurations are easy to discuss as distinct types, relevant evidence from attachment theory raises the issue of whether these types may be better conceptualized as dimensions, with different configurations located within two-dimensional space. Further, findings of a group evidencing mixed anaclitic and introjective features raise additional questions about how these configurations relate to one another, and evidence from the attachment literature is used to shed light on this issue.     

The Depressive Experiences Questionnaire: A Critical Review

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) is critically reviewed. First the developmental, object representations theory differentiating depression into anaclitic and introjective subtypes is presented. The DEQ factors of Dependency and Self-Criticism were initially found to be consistent with these clinically meaningful depressive subtypes. Subsequent research has generally demonstrated that these subtypes, at least as measured by the DEQ, do not hold up well in clinical populations. Furthermore, the validity of the developmental theory of these subtypes is weak. We suggest that more internally consistent and distinct factors should be developed from clinical populations because of their potential clinical usefulness.     

The Depressive Experiences Questionnaire: a further evaluation

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976b) was designed to assess the introjective and anaclitic personality dimensions hypothesized by Blatt (1974) to underlie different forms of depression. Welkowitz, Lish, and Bond (1985) revised the DEQ (RDEQ) in order to simplify its scoring and facilitate cross-gender comparisons. The study described herein explored the relation between the original and revised forms of the DEQ and assessed the reliability and validity of the Welkowitz et al. (1985) version of the inventory. Two samples were employed: (a) 163 psychiatric outpatients; and (b) 144 adolescent and young-adult offspring of patients with major affective disorders, chronic physical diseases, and normal controls. The results indicated that the three scales comprising the RDEQ were highly correlated with the corresponding scales from the original DEQ, however, the original and revised forms of the inventory exhibited different patterns of intercorrelations between scales. The RDEQ was internally consistent and stable over a 6-month period. In addition, it exhibited the predicted patterns of relationships with interview and self-report measures of depression and depressive personality traits and cognitive styles. Finally, the RDEQ was significantly associated with the course of depression in a 6-month follow-up study. The findings were generally similar across samples and genders. Overall, these results support the reliability and validity of the RDEQ, but indicate that there are important structural differences between the original and revised forms of the inventory.     

The Depressive Experiences Questionnaire: A Further Evaluation

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976b) was designed to assess the introjective and anaclitic personality dimensions hypothesized by Blatt (1974) to underlie different forms of depression. Welkowitz, Lish, and Bond (1985) revised the DEQ (RDEQ) in order to simplify its scoring and facilitate cross-gender comparisons. The study described herein explored the relation between the original and revised forms of the DEQ and assessed the reliability and validity of the Welkowitz et al. (1985) version of the inventory. Two samples were employed: (a) 163 psychiatric outpatients; and (b) 144 adolescent and young-adult offspring of patients with major affective disorders, chronic physical diseases, and normal controls. The results indicated that the three scales comprising the RDEQ were highly correlated with the corresponding scales from the original DEQ, however, the original and revised forms of the inventory exhibited different patterns of intercorrelations between scales. The RDEQ was internally consistent and arable over a 6-month period. In addition, it exhibited the predicted patterns of relationships with interview and self-report actuates of depression and depressive personality traits and cognitive styles. Finally, the RDEQ was significantly associated with the course of depression in a 6-month follow-up study. The findings were generally similar across samples and genders. Overall, these remits support the reliability and validity of the RDEQ, but indicate that there are important structural differences between the original and revised forms of the inventory.     

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

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.     

Depression,gender, gender role traits,and the wish to be held

Different forms of the wish to be held were examined with measures of femininity, masculinity, and various types of depression in a sample of normal young adults whose ethnicity resembled that of national statistics. Women reported greater wishes to be held than men. However, the wish to be held, which was uncorrelated with depressive symptomatology, related positively to femininity and feelings of efficacy for men, but positively to anaclitic and introjective depression for women. For women, gender role traits also were important for wishes to be held entailing themes of strategy and deprivation. Since gender differences regarding various depressive experiences did not account for these findings, the wish to be held may have different meanings for men and women.     

The Depressive Experiences Questionnaire: a critical review

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) is critically reviewed. First the developmental, object representations theory differentiating depression into anaclitic and introjective subtypes is presented. The DEQ factors of Dependency and Self-Criticism were initially found to be consistent with these clinically meaningful depressive subtypes. Subsequent research has generally demonstrated that these subtypes, at least as measured by the DEQ, do not hold up well in clinical populations. Furthermore, the validity of the developmental theory of these subtypes is weak. We suggest that more internally consistent and distinct factors should be developed from clinical populations because of their potential clinical usefulness.     

Dependency and self-criticism as predictors of suicidal behavior

Individuals have been theorized to develop anaclitic and introjective depression to the extent that they may be characterized as dependent and self-critical, respectively (e.g., Blatt, 1990). Blatt's theory was applied to suicidal behavior to determine if suicidal behavior could also be reliably broken down into two distinctive types, with respect to a number of parameters. Sixty-four undergraduate students who had attempted suicide were interviewed, and the lethality of their attempts was assessed with the Risk-Rescue Rating scale (Weisman & Worden, 1972). Participants were also administered an Intent and Precipitating Events scale, a modified version of the BDI-II, and the Depressive Experiences Questionnaire (DEQ). Self-critical individuals showed greater intent to die and greater lethality in their suicide attempts than did dependents. Self-critics were also more likely to attempt in response to an intrapsychic stressor, with the explicit motivation to escape. In contrast, dependents were more likely to attempt in response to an interpersonal stressor, with the motivation to communicate some form of unhappiness. Implications for suicide prediction and treatment are discussed, with special reference to the importance of identifying different suicidal subtypes.     

Anger and the Use of Defense Mechanisms in College Students

ABSTRACT It was hypothesized that experimentally induced anger would result in an increased use of defense mechanisms in college students. As predicted from the theory of defense mechanism development, the Thematic Apperception Test (TAT) stories of angered students showed a higher level of use of projection and identification, and the use of these defenses was significantly correlated with the presence of aggressive content in the stories. The results were consistent with previous studies in showing that the predominant defenses of late adolescents are projection and identification, and that men use more projection than women.     

Two Distinctive Personality Configurations: Understanding the Therapeutic Context with Suicidal Individuals

Recent theory and research have associated different levels and types of suicide risk with particular personality dimensions, focusing particularly on the distinction between introjective and anaclitic personality orientations. This distinction is discussed in relation to our general understanding of the therapeutic context with those who have attempted, or may be at risk for, suicidal behavior. Individuals characterized as predominantly introjective/self-critical or as anaclitic/dependent seem to represent relatively homogenous subgroups of suicidal individuals, with distinct concerns, vulnerabilities, and behaviors. Our conclusion is that persons in these subgroups seem to warrant different intervention and therapeutic strategies. Implications for the psychotherapeutic process are discussed.