Psychotherapy of Self-Criticism in a Case of Mixed Anaclitic-Introjective Depression

Abstract

In this case study, the year-long psychotherapy of a depressed and self-critical 34-year-old women is described. Her depression was conceptualized as a “mixed” anaclitic and introjective type according to the model of Sidney Blatt. Anaclitic depression involves a preoccupation with the integrity of interpersonal relatedness (e.g., issues of dependency and abandonment), whereas introjective depression involves a preoccupation with autonomy and self-esteem (e.g., self-criticism and feelings of worthlessness). Given the potentially destructive nature of self-criticism, the therapist systematically confronted the patient’s use of this trait in a supportive manner. Changes in the patient’s functioning were assessed at the beginning and at the end of treatment using the Shedler-Westen Assessment Procedure and the Diagnostic and Statistical Manual of Mental Disorders (4th edition) Global Assessment of Functioning Scale. After 1 year of psychotherapy combining both cognitive and psychodynamic interventions, the patient evidenced significant changes in both anaclitic and introjective personality dimensions and showed significant improvements in adaptive functioning.