Sidney J. Blatt’s research while affiliated with Universidade de Évora and other places

The research literature consistently indicates that self-criticism is related to suicidality. Evidence for the role of dependency, however, is more controversial. This study examines the extent to which these personality vulnerabilities are mediated by psychological distress in the prediction of suicidality. As part of a study of adolescent psychopathology, a sample of 260 Portuguese adolescents (148 [56.9 %] female and 112 [43.1%] male), ranging in age from 15 to 18 years (M = 16.32, SD = 1.19) completed measures of personality, suicidal behavior, and current distress, in counterbalanced order. The measures were: self-criticism and dependency from the Depressive Experiences Questionnaire for Adolescents; two psychological distress scales, social withdrawal from the Youth Self Report and depression from the Center for Epidemiologic Studies of Depression Scale; and a measure of suicidality from the Suicide Behaviors Questionnaire Revised. Structural equation modeling indicated that self-criticism and dependency were both significantly associated with suicidality. Psychological distress, however, as measured by withdrawal and depression, fully mediated these relationships, but did not moderate them. The authors conclude that adolescents with higher levels of self-criticism and dependency are at greater risk for experiencing intense psychological distress-high levels of social withdrawal and depression-that account for their vulnerability to suicide risk.

The Depressive Experiences Questionnaire (DEQ, Blatt, D’Afflitti, & Quinlan, 1976, 1979), a self-report measure used in personality research, assesses the constructs of Dependency and Self-Criticism as vulnerability factors in depression (Blatt, 1974, 1990, 2004) and psychopathology more generally (Blatt, 2008; Blatt & Shichman, 1983). This study establishes a Portuguese version of the DEQ with six samples: a bilingual sample to test the measurement equivalence of the Portuguese DEQ, and two college student samples, two community samples and a clinical sample, to test the reliability, factor structure and criterion, convergent and predictive validity of this translation of the DEQ. A measure of depression (Center for Epidemiologic Studies Depression Scale; CES-D; Radloff, 1977) and of general psychopathology (Brief Symptom Inventory; BSI; Derogatis, 1993) evaluated the convergent validity of the DEQ. Findings indicate satisfactory reliability and validity of the Portuguese DEQ, and the value of the DEQ for investigating the relationship between personality and depression and between personality and psychopathology more generally. It is important to note, however, that these conclusions are based on a limited clinical sample. Additional reliability and validity data are needed with a larger clinical sample.

This article considers the importance of focusing on the patient’s experiential world in the treatment process. It also presents an evidence-based conceptual model of personality development and psychopathology that enabled investigators to introduce aspects of patients into research designs so they could explore patient-treatment and patient-outcome interactions—interactions that address complex questions such as what kinds of treatments are most effective with what types of patients and that suggest that different, but equally desirable, therapeutic outcomes occur through differing mechanisms of therapeutic action. Consistent with clinical experiences discussed in the earlier sections of this article, results from three studies of long-term, psychodynamically oriented treatment, and from a randomized clinical trial investigating several brief manual-directed treatments for depression, demonstrate the importance of focusing on the contributions of patients to the treatment process in both clinical practice and research. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

David Shapiro, in an unpublished paper titled: On two fundamental categories of psychopathology,notes that he and I via different routes, have arrived at the same conclusion that there are two fundamental categories of psychopathology. Shapiro notes a general congruence of his concepts of a rigid mode and a passive-reactive mode (e.g., Shapiro, 1981, 2000) and my formulations of anaclitic and introjective configurations of personality development, personality organization and psychopathology (e.g., Blatt, 1974, 1990, 1991, 2006, 2008; Blatt and Shichman, 1983). But Shapiro also notes that on a certain important point concerning both etiology and dynamics [we] clearly diverge and he discusses our divergence about the dynamics of psychopathology and perhaps also its etiology. This paper articulates more fully this divergence and why I, in contrast to Shapiro, think it important to include aspects of the etiology and dynamics in formulations of the two configurations of psychopathology. I briefly cite studies that demonstrate the validity of some the assumptions about the etiology and dynamics of the anaclitic and introjective configurations of personality organization and psychopathology and how these assumptions facilitate the articulation of a theoretically coherent and comprehensive model of psychological development, personality organization and psychopathology that has etiologic as well as therapeutic implications.

The authors integrate explorations by Blatt and colleagues of contributions of patient personality, therapeutic relationship, and change in mental representation to sustained therapeutic change. A pretreatment personality characteristic, self-critical perfectionism, a negative self-schema, significantly interfered with therapeutic progress in manual-directed, brief outpatient treatment for depression. The therapeutic relationship, however, facilitated changes in this negative self-representation, leading to sustained therapeutic change. The authors also explored change in the content and structural organization of representations of self and significant others in long-term, intensive inpatient treatment. A detailed clinical example elaborates the processes through which the therapeutic relationship facilitates changes in the thematic content and cognitive structural organization of patients' interpersonal schemas that appear to be the basis for sustained therapeutic gain.

This paper presents a psychodynamic approach to depression based on theoretical formulations and empirical findings from diverse perspectives including developmental psychopathology, cognitive and developmental psychology, social and personality theory, and psychiatric genetics. This approach considers depression not as a disease but as distortions of the normal development of two fundamental psychological processes: the capacity for interpersonal relatedness and the establishment of self-definition or an identity. The first section of this paper discusses depression in terms of two broad types of early and later life experiences that create vulnerabilities that can lead to depression: an interpersonal or anaclitic vulnerability that includes experiences of loss and feelings of loneliness, and a self-definitional or introjective vulnerability that includes experiences of failure and loss of self-esteem and self-worth. Extensive research over the last 25 years, summarized in the second section of this paper, supports and extends these theoretical formulations about two primary nuclei in depression. The third section considers the clinical implications of these formulations, particularly the impact of patient characteristics on differential response to various types of treatments, resulting in different types of clinical outcome. These theoretically and clinically derived, and empirically supported formulations of depression have implications for the aetiology and treatment of depression and suggest the importance of focusing on the phenomenology rather than the symptoms of depression and of considering the complex interactions between genetic predispositions, personality development, and early and later life experiences in the pathogenesis and treatment of depression.

Extensive analyses of data from the remarkably comprehensive data set established by the Treatment of Depression Collaborative Research Program (TDCRP), initiated and conducted by the National Institute of Mental Health (NIMH), enabled us to examine the contributions of three dimensions of the treatment process (type of treatment, aspects of the therapeutic relationship, and patients' pretreatment personality characteristics) to three assessments of therapeutic change (symptom reduction, reduction of vulnerability, and development of adaptive capacities) evaluated at termination and extended follow-up. The most consistent factors predicting therapeutic gain were the quality of the therapeutic relationship and patients' pretreatment personality dimensions. The implications of these findings for clinical practice, training, and research are discussed. (c) 2005 Elsevier Ltd. All rights reserved.