Anaclitic and Introjective Personality Distinctions among Psychotherapy Outpatients: Examining Clinical Change across Baseline and Therapy Phases

S. J. Blatt and colleagues (e.g., Blatt, 1995; Blatt & Blass, 1996; Blatt & Shichman, 1983) have theorized that individuals develop and function along two basic lines— that of interpersonal relatedness and that of self-definition. These two modes, while moderately-oscillatory across the lifespan, suggest two respective, relatively-fixed, personality configurations—the anaclitic and the introjective. It is suggested that psychopathology arises when investment in the themes of one’s preferred personality configuration become enduringly over-emphasized. Individuals with anaclitic psychopathologies tend to be plagued by feelings of helplessness and weakness, and they tend to have fears of being abandoned; they generally have a depleted sense of self. Individuals with introjective psychopathologies tend to be plagued by feelings of guilt, self-criticism, and inadequacy; they generally have a distorted sense of self. Some individuals struggle with both types of feelings and problems. Previous research, conducted mostly among seriously disturbed inpatients in long-term therapy, with only a few measurements over time, suggests differential responses to treatment as a function of these anaclitic—introjective distinctions. Uniquely, the present study employs a form of hierarchical modeling, using continuously collected outcome measurements, to examine therapeutic course and outcome in relatively short-term psychotherapy among outpatients. More specifically, it tests a number of hypotheses examining the role of personality configuration in clinical change during baseline as well as therapy phases. Results indicate that duration-of therapy, and therapeutic alliance levels did not differ significantly as a function of personality configuration; pre-treatment level of symptomotology did not differ between anaclitic and mixed-type patients, and was lower among introjective patients—who as a group reported a symptomotology-level that was subclinical. In the sample as a whole, significant symptom improvement occurred during baseline-phase—most of which was driven by clear improvement in the anaclitic and mixed-type groups, while attenuated some by the lack of improvement in the introjective group. During therapy-phase, patients as a whole, and by group, did not report any meaningful change in symptomotology. Several possible explanations for this no-therapy-effect phenomenon, as well as study-limitations, are discussed