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Sidney J Blatt

Publications and source records attributed to Sidney J Blatt.

16 recordsLinked to original sources
PubMed2007

Dependency and self-criticism: relationship with major depressive disorder, severity of depression, and clinical presentation.

Dependency and self-criticism have been proposed as personality dimensions that confer vulnerability to depression. In this study we set out to investigate the diagnostic specificity of these personality dimensions and their relationship with gender differences, severity of depression, and specific depressive symptoms. Levels of dependency and self-criticism as measured by the Depressive Experiences Questionnaire (DEQ) were compared among patients with major depressive disorder (MDD; n=93), mixed psychiatric patients (n=43), university students (n=501), and community adults (n=253). Associations with severity of depression and specific depressive symptoms were also explored. Results showed that dependency was more specifically associated with MDD, whereas self-criticism did not differ between depressed and mixed psychiatric patients. In line with the gender incongruence hypothesis, women with MDD and other psychiatric disorders had higher levels of self-criticism compared to men, whereas men with MDD had higher levels of dependency compared to women. Severity of depression was more clearly linked to self-criticism than to dependency, particularly in patients with MDD. Finally, both dependency and self-criticism were related to theoretically predicted clusters of depressive symptoms, especially after we controlled for shared variance between self-critical and dependent symptoms, respectively. Limitations of this study include the cross-sectional design, which limited the ability to draw causal conclusions. In addition, this study relied exclusively on self-reported personality and mood. Overall, findings of this study suggest that both dependency and self-criticism are associated with MDD, severity of depression, and specific depressive symptoms, and that gender-incongruent personality traits may be associated with increased risk for depression and other disorders.

Adult↗
PubMed2006

Depression research and treatment: are we skating to where the puck is going to be?

This paper critically reviews empirical findings regarding current key assumptions underlying the nature and treatment of depression which heavily rely on the DSM approach. This review shows that empirical evidence provides little support for these assumptions. In response to these findings, an etiologically based, biopsychosocial, dynamic interactionism model of depression is proposed. This model could foster further integration in research on depression and assist in the development of guidelines for the treatment of depression that are better informed by research findings and more congruent with complex clinical realities.

Depression↗
PubMed2006

Self-criticism and depressive symptomatology interact to predict middle school academic achievement.

Although previous research has implicated adolescent depression in academic difficulties, few studies have explored the role of cognitive/personality factors in this area. To address this gap, the present study examines the role of self-criticism in academic functioning among early adolescent students over a 1-year interval. We hypothesized and found that adolescent self-criticism and depressive symptomatology interacted to predict decreased grade point average (GPA) over time, an interaction that was found predominantly in boys. This finding illustrates the need to integrate research on personality and psychopathology into educational psychology.

Adolescent↗
PubMed2006

The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced adaptive capacities.

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed from these relationship measures. Multilevel modeling demonstrated that a perceived positive therapeutic relationship early in treatment predicted more rapid decline in maladjustment subsequent to the relationship assessment. This effect occurred equally across all 4 treatment conditions. A positive early therapeutic relationship also predicted better adjustment throughout the 18-month follow-up as well as development of greater enhanced adaptive capacities (EAC). Controlling a wide range of patient characteristics did not eliminate the effects of the therapeutic relationship on rate of improvement during treatment and on EAC. Thus, independent of type of treatment and early clinical improvement, the therapeutic relationship contributes directly to positive therapeutic outcome.

Adaptation, Psychological↗
PubMed2006

The relationship of perfectionism, depression, and therapeutic alliance during treatment for depression: latent difference score analysis.

The authors examined the longitudinal relationship of patient-rated perfectionism, clinician-rated depression, and observer-rated therapeutic alliance using the latent difference score (LDS) analytic framework. Outpatients involved in the Treatment for Depression Collaborative Research Program completed measures of perfectionism and depression at 5 occasions throughout treatment, with therapeutic alliance measured early in therapy. First, LDS analyses of perfectionism and depression established longitudinal change models. Further LDS analyses revealed significant longitudinal interrelationships, in which perfectionism predicted the subsequent rate of depression change, consistent with a personality vulnerability model of depression. In the final LDS model, the strength of the therapeutic alliance significantly predicted longitudinal perfectionism change, and perfectionism significantly predicted the rate of depression change throughout therapy. These results clarify the patterns of growth and change for these indicators throughout depression treatment, demonstrating an alternative method for evaluating longitudinal dynamics in therapy.

Adult↗
PubMed2006

Minding the gap between positivism and hermeneutics in psychoanalytic research.

Two quite different cultures are to be found within psychoanalysis, one more clinical in orientation, more focused on meaning and interpretation, and relying primarily on the traditional case study method, the other more research-oriented, focused on cause-and-effect relationships, and relying primarily on methods borrowed from the natural and social sciences. The history of this divide is reviewed and arguments, pro and con, about the potential contributions of specific types of empirical investigation are discussed. Increasingly, it seems, criticisms concerning the scientific status of psychoanalysis are being responded to by empirical research. This has contributed to a growing recognition within the scientific community of the credibility of aspects of psychoanalytic theories and of the effectiveness of psychodynamic treatment. However, some segments of the psychoanalytic community are concerned that this increase in the quantity and quality of empirical research on psychoanalytic concepts risks creating an empirical one-sidedness, while other segments are concerned that not engaging in systematic empirical research can lead to intellectual isolation, fragmentation, stagnation, and orthodoxy. To counter this polarizing tendency, a recommendation is made for methodological pluralism. Adopting this stance could contribute to an enriched understanding of the clinical process and to the development of new research methodologies to investigate complex psychodynamic hypotheses, thus bridging the gap between the two psychoanalytic cultures, as well as the gap between research and clinical practice.

Humans↗
PubMed2006

A personal odyssey.

In this autobiography, I tried to capture important aspects of my personal and professional development from my childhood in the ethnic ghettos of South Philadelphia to Pennsylvania State University and the University of Chicago and eventually to over 45 years on faculty at Yale. It has been a journey that I could never have anticipated and that has given me a sense of the unpredictability of psychological development. We all evolve in an open system and a significant portion of the variance of the outcome is determined by fate. But much is also determined by the ability to recognize opportunities and the willingness to take chances and to work hard when opportunities arise. As I reflect on my career of over 50 years, I have been delighted that I opted for a career as a clinical psychologist because it has provided me with opportunity to develop clinical skills and to combine these skills with scholarship and research. While I take considerable satisfaction in the recognition that my contributions have received, the most important aspect of my career has been my relationship with students and colleagues. These collaborations have clearly enriched my work; but more important, they have enriched my life.

History, 20th Century↗
PubMed2005

Empirical evaluation of the assumptions in identifying evidence based treatments in mental health.

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.

Cognitive Behavioral Therapy↗
PubMed2005

Changes in representations of a self-designated significant other in long-term intensive inpatient treatment of seriously disturbed adolescents and young adults.

Blatt and colleagues (1996) found that severity of psychopathology in seriously disturbed, treatment-resistant, hospitalized adolescents at the beginning of treatment was positively correlated with the degree to which these adolescents were involved in describing their parents. At the end of long-term, intensive, psychodynamically oriented, inpatient treatment of these very troubled adolescents, reduction in the severity of psychopathology correlated significantly with increases in the development of the structural organization of descriptions of mother, father, self, and therapist. These findings suggested that treatment of seriously disturbed, treatment-resistant, adolescent and young adult inpatients seems to involve at least two primary dimensions: 1) disengagement from an intense involvement with parents and 2) development in the structural organization of representations of self and a significant new figure, the therapist. The present study extends these earlier findings by examining changes in the description of a "significant other" that each patient elected to describe at the beginning and the end of treatment. Clinical improvement over the course of treatment was significantly correlated with developmental progression of the significant figure each patient selected to describe (from a grandparent to a close friend) as well as with progression in the developmental organization in which this significant other was described. These findings suggest that treatment of seriously disturbed adolescents and young adults involves a disengagement from an intense involvement with primary caregivers to involvement with others outside the family matrix and the developmental elaboration of the representation of these figures.

Adolescent↗
PubMed2004

An interactive-synergetic approach to the assessment of personality vulnerability to depression: Illustration using the adolescent version of the Depressive Experiences Questionnaire.

Research on personality vulnerability to depression is characterized by a "main effect" approach, often at the expense of examining interactions among various dimensions of vulnerability. To compare the "main effect" and "interactive-synergetic" approaches, we utilized data from a longitudinal study of adolescent adjustment. Focusing on dependency, self-criticism, and efficacy, the three factors of the adolescent version of the Depressive Experiences Questionnaire (DEQ; Blatt, Schaffer, Bers, & Quinlan, 1992), we found support for the interactive-synergetic approach. Dependency and self-criticism interacted in predicting changes in depressive and internalizing symptoms (under low efficacy), and among boys-changes in internalizing and externalizing symptoms. Results illuminate the synergetic interplay among dimensions of risk and resilience in clinical research and practice.

Adaptation, Psychological↗
PubMed2004

The sense of self in anorexia-nervosa patients: a psychoanalytically informed method for studying self-representation.

This paper has two purposes: to study a central psychological feature of anorexia nervosa, the disturbed sense of self, and to demonstrate the utility of an empirical research method to explore a psychoanalytic concept such as self-representation. The aim of the study was to distinguish the sense of self of anorexia-nervosa patients from that of other psychiatric patients, as well as from non-patients. We obtained open-ended self-descriptions, which provide access to self-representations, from 77 young women between the ages of 14 and 24 who made up three groups-anorexia-nervosa patients (n = 15), control psychiatric patients (n = 15), and control non-patients (n = 48). The self-descriptions, when rated on 18 scales that fell into four factors (Agency, Reflectivity, Differentiation, and Relatedness) and two affective scales (Anxiety and Depression), showed that the two patient groups shared characteristics that significantly differentiated them from women who were not patients-a lower sense of agency and relatedness. What significantly differentiated the anorexia-nervosa patients from the other psychiatric patients, as well as from the nonpatients, were a heightened and harsh self-reflectivity and more openly expressed depressive and anxious affect in the self-descriptions. The implications for treatment and for understanding eating disorders are discussed.

Adolescent↗
PubMed2004

Psychoanalysis--with whom, for what, and how? Comparisons with psychotherapy.

If psychoanalytic treatment is to survive in the era of evidence-based medicine and managed care systems, empirical evidence is needed to demonstrate its unique nature and effectiveness. To address this need, comprehensive analyses were conducted of data from the Menninger Psychotherapy Research Project (Wallerstein 1986). These analyses addressed three questions: (1) What are the differences in outcome between psychoanalysis (PSA) and supportive-expressive psychotherapy (SEP)? (2) With what types of patient, and in what ways, are these two psychodynamic treatments differentially effective? (3) Are these differences in outcome the consequence of possibly different mechanisms of therapeutic action? PSA was found to contribute significantly to the development of adaptive interpersonal capacities and to the reduction of maladaptive interpersonal tendencies, especially with more ruminative, self-reflective, introjective patients, possibly by extending their associative capacities. SEP, by contrast, was effective only in reducing maladaptive interpersonal tendencies and only with dependent, unreflective, more affectively labile anaclitic patients, possibly by containing or limiting their associative capacities.

Adaptation, Psychological↗
PubMed2004

Stability of the patient-by-treatment interaction in the Menninger Psychotherapy Research Project.

Consistent with the call to consider person-by-treatment interactions in intervention research, Blatt (1992) found that anaclitic and introjective patients responded differently to psychoanalysis and supportive-expressive therapy (SEP) in the Menninger Psychotherapy Research Project (MPRP). Psychoanalysis was significantly more effective than SEP in reducing malevolent, destructive imagery on the Rorschach among introjective patients, those patients who are primarily preoccupied with control and self-definition. Conversely, SEP was significantly more effective than psychoanalysis in reducing these malevolent, destructive images among anaclitic patients, those patients who are primarily preoccupied with interpersonal relatedness. The present analyses of data from the MPRP demonstrate the stability of this statistically significant patient-by-treatment interaction even in the subsample of patients for whom the anaclitic-introjective distinction was ambiguous, reaffirming the validity of both the anaclitic-introjective distinction and the importance of considering patient characteristics in psychotherapy research and practice.

Adult↗
PubMed2003

Interpersonal relatedness, self-definition, and their motivational orientation during adolescence: a theoretical and empirical integration.

The authors examined a theoretical model linking interpersonal relatedness and self-definition (S.J. Blatt, 1974), autonomous and controlled regulation (E. L. Deci & R. M. Ryan, 1985), and negative and positive life events in adolescence (N = 860). They hypothesized that motivational orientation would mediate the effects of interpersonal relatedness and self-definition on life events. Self-criticism, a maladaptive form of self-definition, predicted less positive events, whereas efficacy, an adaptive form of self-definition, predicted more positive events. These effects were fully mediated by the absence and presence, respectively, of autonomous motivation. Controlled motivation, predicted by self-criticism and maladaptive neediness, did not predict negative events. Results illustrate the centrality of protective, pleasure-related processes in adaptive adolescent development.

Adaptation, Psychological↗
PubMed2003

Role of perfectionism and personality disorder features in response to brief treatment for depression.

Using data from the Treatment of Depression Collaborative Research Program (TDCRP), the authors compared the role of patients' perfectionism and features of personality disorder (PD) in the outcome of brief treatment for depression. Data were extracted as to patients' intake levels of symptoms; perfectionism; and PD features, measured as continuous variables, as well as their symptoms at termination; their contribution to the therapeutic alliance; and their satisfaction with social relations. Poorer therapeutic outcome was demonstrated for patients with elevated levels of perfectionism and odd-eccentric and depressive PD features. Patients' contribution to therapeutic alliance and satisfaction with social relations were predicted by perfectionism but not by PD features. Results highlight the central role played by patients' personality in the course of brief treatment for depression.

Depression↗