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

Jeanne A. Layne

University of Detroit Mercy

John H. Porcerelli

Wayne State University School of Medicine

Golan Shahar

Yale University School of Medicine

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.

Key Words: self-criticism • depression • anaclitic depression • introjective depression • psychodymanic psychotherapy • cognitive psychotherapy

Clinical Case Studies, Vol. 5, No. 5, 421-436 (2006)
DOI: 10.1177/1534650106290370
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