Different Kinds of Folks may Need Different Kinds of Strokes: The Effect of Patients' Characteristics on Therapeutic Process and Outcome

In response to recent discussion of the importance of identifying theoretically derived patient characteristics to be included in the study of patient-therapy (PT) and patient-outcome (PO) interactions in psychotherapy research, this paper presents a model of two broad configurations of personality style and psychopathology that appear to be related to aspects of therapeutic process and outcome. Anaclitic psychopathologies are disorders primarily preoccupied with issues of interpersonal relatedness such as trust, caring, intimacy and sexuality, and which use primarily avoidant defenses (e.g., denial and repression) to cope with psychological conflict and stress. In contrast, introjective psychopathologies are disorders primarily concerned with establishing and maintaining a viable sense of self, ranging from a basic sense of separateness, to concerns about autonomy and control, to issues of self-worth, and that use primarily counteractive defenses (e.g., projection, doing and undoing, intellectualization, reaction formation, and overcompensation). This differentiation, made with acceptable reliability from clinical case reports, related significantly to: (a) different types of outcome in long-term intensive treatment of seriously disturbed young adults, and (b) different response to two forms of therapy—psychoanalysis and psychotherapy. These findings are consistent with recent results from the NIMH Treatment of Depression Collaborative Research Project, which indicate that depressed patients with higher levels of social functioning do better in brief interpersonal therapy, while depressed patients with higher cognitive functioning do better in brief cognitive-behavioral therapy. The results of these three studies indicate the importance of including differentiations among patients in psychotherapy research and the potential value of the anaclitic-introjective distinction in studies of psychotherapy process and outcome.