ABSTRACT
In 1992, Sidney Blatt published a paper in the Journal of the American Psychoanalytic Association that profoundly changed our thinking about psychotherapy, and the ef®cacy of different modes of therapeutic treatment. Previously, data from the Menninger Psychotherapy Research Project had indicated that there was little difference in the therapeutic outcome of patients who had been treated with psychoanalysis, as compared with those who had been seen in supportive-expressive psychotherapy. However, Sid's reanalysis of these data, looking at them through a new lens, revealed a different understanding of the relation between type of therapy and treatment outcome. In careful reanalyses of the outcome data, Sid demonstrated that the responsiveness of patients to the two types of treatment was importantly determined by personality differences in the patients. Patients who could be identi®ed as having an anaclitic personality organization ± those who were primarily focused on interpersonal relatedness and who used avoidant defenses like denial ± showed more positive change when provided with supportive-expressive psychotherapy. In contrast, patients who could be identi®ed as having an introjective personality organization ± those who were primarily focused on issues of self-de®nition, autonomy and self-worth and who used counteractive defenses like projection ± showed greater positive change when treated by psychoanalysis. The very important discovery of this work demonstrated that the nature of the therapeutic outcome depended on the interaction between personality organization of the patient and treatment mode.
